The value of the Modified Early Warning Score for unplanned Intensive Care Unit admissions of patients treated in hospital general wards. Issue 3 (1st March 2018)

• Record Type: Journal Article
• Authors: Zografakis‐Sfakianakis, Michail; De Bree, Eelco; Linardakis, Manolis; Messaritaki, Argyri; Askitopoulou, Helen; Papaioannou, Alexandra; Aggouridakis, Panagiotis
• Is Part Of: International journal of nursing practice. Volume 24:Issue 3(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-03-01
• Subjects: critically ill -- intensive care unit -- Modified Early Warning Score -- mortality -- nursing observation; Nursing -- Periodicals; Nursing -- Practice -- Periodicals; 610.73092
• DOI: 10.1111/ijn.12632
• Languages: English
• ISSNs: 1322-7114

Abstract

Abstract: Aim: To determine the value of the Modified Early Warning Score (MEWS) for general ward patients and its potential use as an alarm tool for ward nurses. Methods: A combined prospective‐retrospective observational study was conducted with 153 patients in a university hospital (2013‐2014). All patients were admitted to the intensive care unit (ICU) from general wards. Parameters retrospectively studied were 5 MEWS values at 4 hourly intervals, up to 20 hours before ICU admission. Parameters prospectively studied were ICU length of stay, ICU mortality, and mortality after ICU discharge. Results: Most frequent severe adverse events were acute respiratory failure (39.9%) and septic shock (20.3%). Modified Early Warning Score increased gradually during the last 20 hours, and most patients remained in the wards, above a cut‐off point ≥7 recorded at 4 hours before admission. Significant associations between latest MEWS score and ICU mortality and ICU length of stay were found. MEWS score≥ 7 hours before admission was highly associated with increased ICU and hospital mortality. Conclusion: Patient deterioration in general wards can result in severe adverse events. Modified Early Warning Score is a strong predictor of outcome and may be used as a monitoring tool for potentially avoidable deaths and unplanned admissions to ICU. SUMMARY STATEMENT: What is already known about this topic? The health of patients admitted to general hospital wards may deteriorate, or the severity of their clinical condition might be underestimated at the time of admission. Care may be suboptimal in general wards, compared with what routine nursing observations indicate may be required. Early Warning Scoring systems combine vital signs with clinical measurements and were introduced to identify patient deterioration. What this paper adds? A significant percentage of patients had increased MEWS values, even 20 hours before their ICU admission. Patients with an unplanned ICU admission were more often nursed in medical rather than surgical wards, and the most frequent reason for admission was acute respiratory failure following by sepsis. ICU length of stay is related to MEWS values measured even 8 hours before ICU admission. The implications of this paper: Implementing the MEWS may enable early recognition of deterioration in general ward patients. Since reduction of in‐hospital mortality is a universal priority, implementation of an early warning system such as MEWS could be an effective step towards achieving this target. Using the MEWS, nurses "talk a common concise language" with doctors regarding patient assessment in emergency situations.