title: Standardized measurement of the Modified Early Warning Score results in enhanced implementation of a Rapid Response System: a quasi-experimental study.
abstract: OBJECTIVE
  To study the effect of protocolized measurement (three times daily) of the Modified Early Warning Score (MEWS) versus measurement on indication on the degree of implementation of the Rapid Response System (RRS).
  
  
  METHODS
  A quasi-experimental study was conducted in a University Hospital in Amsterdam between September and November 2011. Patients who were admitted for at least one overnight stay were included. Wards were randomized to measure the MEWS three times daily ("protocolized") versus measuring the MEWS "when clinically indicated" in the control group. At the end of each month, for an entire seven-day week, all vital signs recorded for patients were registered. The outcomes were categorized into process measures including the degree of implementation and compliance to set monitoring standards and secondly, outcomes such as the degree of delay in physician notification and Rapid Response Team (RRT) activation in patients with raised MEWS (MEWS≥3).
  
  
  RESULTS
  MEWS calculations from vital signs occurred in 70% (2513/3585) on the protocolized wards versus 2% (65/3013) in the control group. Compliance with the protocolized regime was presents in 68% (819/1205), compliance in the control group was present in 4% (47/1232) of the measurements. There were 90 calls to primary physicians on the protocolized and 9 calls on the control wards. Additionally on protocolized wards, there were twice as much RRT calls per admission.
  
  
  CONCLUSIONS
  Vital signs and MEWS determination three times daily, results in better detection of physiological abnormalities and more reliable activations of the RRT.
authors.affiliation: Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.ludikhuize@amc.uva.nl.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Ludikhuize
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: m.j.borgert@amc.uva.nl.
authors.forename: Marjon
authors.initials: M
authors.lastname: Borgert
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: j.m.binnekade@amc.uva.nl.
authors.forename: Jan
authors.initials: J
authors.lastname: Binnekade
authors.affiliation: Department of Acute, Respiratory and Critical Care Medicine, Bangor University, Bangor, United Kingdom. Electronic address: csubbe@hotmail.com.
authors.forename: Christian
authors.initials: C
authors.lastname: Subbe
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: d.a.dongelmans@amc.uva.nl.
authors.forename: Dave
authors.initials: D
authors.lastname: Dongelmans
authors.affiliation: Department of Quality Assurance and Process Innovation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: a.goossens@amc.uva.nl.
authors.forename: Astrid
authors.initials: A
authors.lastname: Goossens
mesh_terms: D018806:APACHE; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002985:Clinical Protocols; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team / Q000592:standards*; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards*; D009426:Netherlands / Q000453:epidemiology; D055986:Vital Signs
keywords: Cardiopulmonary arrest; Modified Early Warning Score; Rapid Response System; Rapid Response Team; Unplanned ICU admission; Vital signs