title: Use of a patient information system to audit the introduction of modified early warning scoring.
abstract: Modified early warning scoring (MEWS) uses abnormalities in routine observations to identify patients at risk of critical illness. Nurses recorded scores at or above the medical response score of 3 on a hospital clinical information system during the first year of introducing MEWS to 10 wards in a university hospital. A total of 619 triggers were recorded in 365 patients. Fifty-nine required intensive care unit (ICU)/high dependency unit (HDU) care; 71 died. Survival was significantly worse for initial scores >4 (35/104 patients died) than for scores 3-4 (P<0.004). Multivariant analysis showed age (P<0.001) and trigger score (P<0.001) but not ward specialty (P=0.1) predicted death. Mean ages of survivors and non-survivors were 64 years (SD 18) and 74 years (SD 17), respectively. Addition of a score for age did not significantly increase the area under a receiver operator characteristic curve for the predictive value of MEWS scores. The study shows that increasing MEWS score is associated with worse outcome across a range of specialties and that nursing staff will use a patient information system to audit MEWS scores.
authors.affiliation: Medical Student, University of Manchester, Manchester, UK.
authors.forename: C P J
authors.initials: CP
authors.lastname: Quarterman
authors.forename: A N
authors.initials: AN
authors.lastname: Thomas
authors.forename: M
authors.initials: M
authors.lastname: McKenna
authors.forename: R
authors.initials: R
authors.lastname: McNamee
mesh_terms: D000368:Aged; D003422:Critical Care; D003625:Data Collection / Q000379:methods; D006751:Hospital Information Systems; D017052:Hospital Mortality; D006801:Humans; D008330:Management Audit / Q000379:methods*; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology