Use of a patient information system to audit the introduction of modified early warning scoring.
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.
Quarterman
C P J
CP
Medical Student, University of Manchester, Manchester, UK.
Thomas
A N
AN
McKenna
M
M
McNamee
R
R
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