title: The effect of a critical care outreach service and an early warning scoring system on respiratory rate recording on the general wards.
abstract: OBJECTIVE
  To determine whether the implementation of a Reading-Modified Early Warning Scoring (R-MEWS) system, is associated with an increased recording of respiratory rate (RR) in hospital inpatients, and whether the presence of a critical care outreach (CCO) service has a further impact on the recording of patient's vital signs.
  
  
  METHODS
  Five annual point prevalence surveys of all adult, non-obstetric acute inpatients (n=2638) in two Hospitals (A and B) were carried out between 2001 and 2005. The R-MEWS system was implemented incrementally in both hospitals to include all study group patients, but a CCO service was only available in Hospital A. Data were collected on numbers of patients, routinely documented physiological observations and R-MEW score.
  
  
  RESULTS
  Respiratory rate (RR) recording increased from 6.0% in the first survey to 77.9% in the last, which correlated with the incremental implementation of the R-MEWS system. Hospital A that had the CCO service showed a greater increase in RR recording than Hospital B with no CCO service.
  
  
  CONCLUSIONS
  The introduction of an early warning scoring (EWS) was associated with improved respiratory rate recording, which may have been further enhanced by the presence of a CCO service.
authors.affiliation: Critical Care Outreach, Department of Intensive Care, Royal Berkshire NHS Foundation Trust, Reading, UK. mandy.odell@royalberkshire.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Odell
authors.forename: I J
authors.initials: IJ
authors.lastname: Rechner
authors.forename: A
authors.initials: A
authors.lastname: Kapila
authors.forename: T
authors.initials: T
authors.lastname: Even
authors.forename: D
authors.initials: D
authors.lastname: Oliver
authors.forename: C W H
authors.initials: CW
authors.lastname: Davies
authors.forename: L
authors.initials: L
authors.lastname: Milsom
authors.forename: A
authors.initials: A
authors.lastname: Forster
authors.forename: K
authors.initials: K
authors.lastname: Rudman
mesh_terms: D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data*; D005568:Forms and Records Control; D006323:Heart Arrest / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007297:Inpatients; D008499:Medical Records; D008991:Monitoring, Physiologic / Q000379:methods* / Q000706:statistics & numerical data; D010362:Patients' Rooms; D015995:Prevalence; D015656:Respiratory Mechanics / Q000502:physiology*; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology