Background:
The Modified Early Warning Score (MEWS) was validated in 2001. In recent years hospitals across the US have implemented the MEWS as a Rapid Response Team activation trigger. In Geisinger Medical Center the MEWS was piloted and implemented in 2011.The patient’s admission disposition is based on clinical presentation but summative objective data, such as the ED MEWS, might be useful. Our aim was to compare the demographics and ED MEWS of those patients who were admitted to the hospital versus those who were not. We also compared the MEWS of those patients admitted to the ICU versus those admitted to high dependency units or general wards.
Methods:
The study protocol was approved by Geisinger Medical Center’s IRB. A simple random sample of 3,000 patients (first encounters) seen in the ED between January 1, 2014, and May 31, 2015 and all the demographics and ED MEWS was extracted from the electronic medical records.
Results:
Patient who were admitted to the hospital were older (median 69 years old vs 48 years old, p<0.0001), more frequently were transported to the hospital by ambulance (47.6% vs 17.5%, p<0.0001), and had higher ED MEWS than patients not admitted to the hospital. Furthermore patient admitted to ICU had higher ED Maximum MEWS and ED Average MEWS (medians of 4 and 3, respectively) than patients admitted to high dependency unit (3 and 1.8) and general wards (2 and 0.8) (p<0.0001).
Conclusions:
Higher ED MEWS is associated with higher odds of being admitted to the hospital and ICU. ED MEWS may be more systematically used when deciding whether and where patients should be admitted. Doing so might impact medical care delivery and patient flow. Upcoming analysis will explore whether MEWS is associated with clinical events such as transfer to higher level of care, length of stay, and mortality at our institution.