Abstract 12630: Implementation of Modified Early Warning Score (MEWS) Reduces in Hospital Mortality and Hospital Length of Stay
Background: Most in-hospital adverse events are often preceded by warning signs of clinical instability. These early signs typically involve subtle changes in multiple parameters rather than a dramatic change in an isolated value and are frequently overlooked by healthcare providers. MEWS is a weighted score based on 5 basic bedside parameters: systolic blood pressure, heart rate, respiratory rate, temperature, and level of consciousness. It has been developed in an attempt to assist healthcare providers with the early detection of patients with potential for clinical deterioration.
Objective: To examine the impact of proactive MEWS based rounding and intervention on in-hospital mortality and hospital length of stay (LOS).
Methods: This study was conducted in three urban university hospitals following implementation of a MEWS-based algorithm for early intervention in March 2013. Inpatient nurses were trained to observe patients MEWS at four hour intervals. For MEWS of 4, nurses were encouraged to call the physician and to increase clinical monitoring. For MEWS >4, nurses were encouraged to activate the Early Response Team (ERT). We compared the incidence of code blue activation, ERT activation, in hospital mortality and hospital LOS prior to, and after, the implementation of MEWS.
Results: The overall post-MEWS hospital mortality rate (0.016) was significantly lower than the pre-MEWS mortality (0.019); p=0.0142. Overall LOS was also lower in the post-MEWS period by 0.3 days. Observed mortality in the post-MEWS period was significantly lower than the expected mortality (0.016 vs. 0.025; p<.0001). The proportion of patients requiring ERT activations was higher in the post-MEWS period (4.01% vs 3.32%), but the proportion of patients requiring repeat ERTs was lower (18.3% vs 22.1%). The proportion of patients requiring code blue activation was also higher in the post-MEWS period (0.53% vs 0.33%), but part of this observation may be explained by the higher expected mortality in the post-MEWS period.
Conclusions: Implementation of proactive MEWS based rounding was associated with significant decrease in inpatient mortality despite higher expected mortality during this time period. MEWS implementation may also lead to shorter hospital length of stay.
Author Disclosures: K. Stiver: None. N. Sharma: None. S. Lemeshow: None. N. Ijioma: None. S. Chucta: None. R. Husa: None.
- © 2014 by American Heart Association, Inc.