The Emergency Department is a place where critical patient assessment is heavily emphasized. I work as a 4th year nursing clinical extern in the emergency department at my local hospital and there are various factors that can contribute to comprehensive assessments utilized on the floor.

In our ER, the HEWS (Hamilton Early Warning Score) is one assessment that utilizes risk reduction and can prevent further decline in a patient's condition if their vitals are unstable. The HEWS is located on electronic medical records/charts that signal to healthcare providers if there are any issues with a patient's vitals. The scale ranges from a low of 1-4, a medium of 5-6, and a high risk of 7 and above. If a patient has a score of 7, there is an increased likelihood of a transfer to more intensive care, whereas if the patient scores 4 or lower, there is a decreased clinical risk. The score is applied to systolic BP, respiratory rate, temperature, oxygen saturation, oxygen delivery, and neurologic status. For example, if a patient has a systolic blood pressure of less than 70mmHg, they would score a 3 on the HEWS. This does not account for the remaining vitals, which can put the patient already at an increased risk on the scale (Tam et al., 2017).

(Canadian Journal of General Internal Medicine, 2017).

Other important assessments used in Emergency include ABCs (airway, breathing, and circulation), and GCS (Glasgow Coma Scale). Not only are these assessments emphasized in the ER, but they are also used in many other hospital units. ABCs are essential as they are located at the top of Maslow's Hierarchy of Needs (physiological needs) in order for the body to survive. Airway assessment includes observation of airway obstruction, and irregular aspirations/stridor. Breathing determines if there are abnormal respiratory rates, utilization of accessory breathing muscles e.g., tracheal tug, and colour of skin based on oxygen saturation e.g., cyanosis. Circulation determines the circulation of oxygen through the blood e.g., colour of extremities, irregular capillary refill, and decreased LOC (Thim et al., 2012). The GCS consists of 3 categories; best eye response (scored on a scale of 4), best verbal response (scored on a scale of 5), and best motor response (scored on a scale of 6). Earning a score of 13 to 15 indicates low severity of TBI, scoring 9 to 12 indicates moderate severity of TBI, and 3 to 8 indicates severe severity of TBI. The lower the score, the worse the outcome relating to GCS (Jain & Iverson, 2023)

Overall, the importance of assessment in the Emergency Department is crucial for monitoring a patient's condition and should continue to be emphasized throughout admission to discharge.

Jain, S., & Iverson, M. (2023). Glasgow Coma Scale. National Library of Medicine. NIH. https://www.ncbi.nlm.nih.gov/books/NBK513298/

Tam, B., Xu, M. Kwong, M., Wardell, C., Kwong, A., Fox-Robichaud, A. (2017). The Admission Hamilton Early Warning Score (HEWS) Predicts the Risk of Critical Event during Hospitalization. Canadian Journal of General Internal Medicine. https://pdfs.semanticscholar.org/c511/0deba28b721754c416af7de1544f521d580d.pdf 

Thim, T., Krarup, N. H., Grove, E. L., Rohde, C. V., & Løfgren, B. (2012). Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International journal of general medicine, 5, 117–121. https://doi.org/10.2147/IJGM.S28478 Chloe G. September 5, 2023