title: Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.
abstract: This process improvement project aimed to improve the early identification of clinically deteriorating hematology-oncology patients in order to prevent the development of critical illness and to facilitate timely intensive care unit (ICU) transfers. Using failure modes and effects analysis, a protocol employing the Modified Early Warning Score and serum lactate level was implemented to identify deteriorating patients who required the attention of the rapid response team. Control charts revealed a significant decrease in codes and preventable codes, while ICU transfers remained stable. A retrospective analysis to control for age, sex, race, severity of illness, and do not resuscitate status was performed, yielding a codes odds ratio of 0.51 (95% confidence interval = 0.31-0.85) and a preventable codes odds ratio of 0.25 (95% confidence interval = 0.07-0.82). At the study team's institution, implementation of this protocol reduced codes and preventable codes without an associated increase in ICU transfers.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL r-young@northwestern.edu.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Young
authors.affiliation: Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Gobel
authors.affiliation: Northwestern Memorial Hospital, Chicago, IL.
authors.forename: Mark
authors.initials: M
authors.lastname: Schumacher
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Jungwha
authors.initials: J
authors.lastname: Lee
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Charlotta
authors.initials: C
authors.lastname: Weaver
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Sigmund
authors.initials: S
authors.lastname: Weitzman
mesh_terms: D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D000067495:Healthcare Failure Mode and Effect Analysis; D006323:Heart Arrest / Q000517:prevention & control*; D006402:Hematologic Diseases / Q000150:complications*; D057209:Hospital Rapid Response Team; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010360:Patient Transfer; D058996:Quality Improvement; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: clinical deterioration; modified early warning score; oncology care; serum lactate