Standardized measurement of the Modified Early Warning Score results in enhanced implementation of a Rapid Response System: A quasi-experimental study

Purpose

To study the effect of protocolized measurement (three times daily) of the Modified Early Warning Score (MEWS) versus measurement on indication on the degree of implementation of the Rapid Response System (RRS).

Methods

A quasi-experimental study was conducted in a University Hospital in Amsterdam between September and November 2011. Patients who were admitted for at least one overnight stay were included. Wards were randomized to measure the MEWS three times daily (“protocolized”) versus measuring the MEWS “when clinically indicated” in the control group. At the end of each month, for an entire seven-day week, all vital signs recorded for patients were registered. The outcomes were categorized into process measures including the degree of implementation and compliance to set monitoring standards and secondly, outcomes such as the degree of delay in physician notification and Rapid Response Team (RRT) activation in patients with raised MEWS (MEWS ≥ 3).

Results

MEWS calculations from vital signs occurred in 70% (2513/3585) on the protocolized wards versus 2% (65/3013) in the control group. Compliance with the protocolized regime was presents in 68% (819/1205), compliance in the control group was present in 4% (47/1232) of the measurements. There were 90 calls to primary physicians on the protocolized and 9 calls on the control wards. Additionally on protocolized wards, there were twice as much RRT calls per admission.

Conclusions

Vital signs and MEWS determination three times daily, results in better detection of physiological abnormalities and more reliable activations of the RRT.     

改良早期预警评分在预测急诊呼吸系统潜在危重症患者预后中的应用

目的探讨改良早期预警评分(modified early warning score,MEWS)在急诊呼吸系统潜在危重症患者预后中的应用价值。方法对湖北医药学院附属人民医院急诊科2014年5-10月收治的566例呼吸系统患者进行MEWS评分,追踪患者预后,分析MEWS评分与患者预后的相关性;比较存活、死亡患者的MEWS分值和MEWS评分对患者预后鉴别的ROC曲线。结果死亡组MEWS评分高于存活组,差异有统计学意义(t=-10.02,P0.05);MEWS分值与患者预后呈正相关(r=0.63,P0.05)。以死亡为预测指标时,MEWS评分的最佳截断点为3.5分、灵敏度66%、特异度74%、阳性预测值62%、阴性预测值93%、ROC曲线下面积AZ=0.743(95%CI:0.663 0.823)。结论 MEWS评分对急诊呼吸系统潜在危重症患者预后预测有中等的分辨能力,其评分方法简单、实用,可以在急诊呼吸系统患者中使用。     

Changes and their prognostic implications in the abbreviated VitalPAC™ Early Warning Score (ViEWS) after admission to hospital of 18,827 surgical patients

Background

It is not known how often, to what extent and over what time frame any early warning scores change in surgical patients, and what the implications of these changes are.

Setting

Thunder Bay Regional Health Sciences Centre, Ontario, Canada.

Methods

The changes in the first three recordings of the abbreviated version of the VitalPAC™ Early Warning Score (ViEWS) after admission to hospital of 18,827 surgical patients, and their relationship to subsequent in-hospital mortality were examined.

Results

In the 2.0 SD 2.4 h between admission and the second recording the score changed in 12.6% of patients. If the initial abbreviated ViEWS was =2 points (78% of all patients) the in-hospital mortality was 0.5%, and not significantly different in the 3.7% of patients that either increased or decreased their score. Patients who had an initial score =3 had a significantly higher overall in-hospital mortality (odds ratio 5.48, Chi-square 120.72, p < 0.0001). Of these patients, those with a lower second score (42.3% of patients) had a significantly lower in-hospital mortality than those with an unchanged second score (i.e. 1.5% versus 3.3%, odds ratio 0.43, Chi-square 11.08, p < 0.001).

Conclusion

The abbreviated ViEWS score measured on admission identifies the majority of surgical patients who are at low risk of in-hospital death. Patients with an initial abbreviated ViEWS =3 who do not reduce their score within 2–3 h of admission have a further significantly increased mortality.