The Effect Of Modified Early Warning System (MEWS) On Rapid Response Team Call Outcome

Background: Modified Early Warning System(MEWS) is a scoring system based on vitals sign and clinical observation which has been implemented in 2007 as a useful tool to timely recognition and early intervention. The effectiveness of implementation of MEWS as an important tool for rapid response team has been a question and the main objective of our study.

Methods: We carried out a retrospective cohort study of patients who were admitted at a community hospital between November 2011 to June 2017 and had RRT. The MEWS scoring system was implemented in 2015 and we compared the characteristics and outcomes of RRTs in pre and post MEWS era.

Results: A total of 56532 patients were admitted to the hospital between November 2011 and June 2017, of which 898 RRTs were called. The median age of the patients was 68 years and 51% were men. Before the implementation of MEWS, RRT was called on 1.23% of the patients whereas it went up to 2.02% post MEWS score implementation, which was statistically significant (p- 0.03). We also calculated the MEWS score at which RRT was called before MEWS implementation which was higher than the MEWS score post its implementation (4.39 vs 3.95 p-value- 0.0004). The time to RRT from admission fell from 114.87 minutes to 95.7 minutes after the implementation of MEWS (p-value- 0.1). The pre-mews mortality rate of the patients who had RRT was non significantly higher than mortality rate after MEWS implementation (0.19 vs 0.16, p-value 0.22). More patients who had RRT went to home/self-care post MEWS implementation than before it(0.45 vs 0.3939, p-value-0.26). More patients went to a nursing home or became hospice pre-MEWS implementation than after its implementation (0.4 vs 0.38, p-value 0.44).

Conclusions: Implementation of MEWS has significantly increased the RRT rates per admission along with a decrease in MEWS when the RRT was called. Although MEWS implementation did not significantly reduce in time to RRT from admission and mortality rates, there was seen to have a decreasing trend in both of these compared to rates before implementation. Hence the utilization of MEWS has proven to be a useful tool in early recognition of deteriorating patients in our institution.