title: Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital.
abstract: OBJECTIVE
  Severe adverse events such as cardiac arrest and death are often heralded by abnormal vital signs hours before the event. This necessitates an organized track and trigger approach of early recognition and response to subtle changes in a patient's condition. The Modified Early Warning System (MEWS) is one of such systems that use temperature, blood pressure, pulse, respiratory rate, and level of consciousness with each progressive higher score triggering an action. Root cause analysis for mortalities in our institute has led to the implementation of MEWS in an effort to improve patient outcomes. Here we discuss our experience and the impact of MEWS implementation on patient care at our community academic hospital.
  
  
  METHODS
  MEWS was implemented in a protocolized manner in June 2013. The following data were collected from non-ICU wards on a monthly basis from January 2010 to June 2014: 1) number of rapid response teams (RRTs) per 100 patient-days (100PD); 2) number of cardiopulmonary arrests 'Code Blue' per 100PD; and 3) result of each RRT and Code Blue (RRT progressed to Code Blue, higher level of care, ICU transfer, etc.). Overall inpatient mortality data were also analyzed.
  
  
  RESULTS
  Since the implementation of MEWS, the number of RRT has increased from 0.24 per 100PD in 2011 to 0.38 per 100PD in 2013, and 0.48 per 100PD in 2014. The percentage of RRTs that progressed to Code Blue, an indicator of poor outcome of RRT, has been decreasing. In contrast, the numbers of Code Blue in non-ICU floors has been progressively decreasing from 0.05 per 100PD in 2011 to 0.02 per 100PD in 2013 and 2014. These improved clinical outcomes are associated with a decline of overall inpatient mortality rate from 2.3% in 2011 to 1.5% in 2013 and 1.2% in 2014.
  
  
  CONCLUSIONS
  Implementation of MEWS in our institute has led to higher rapid response system utilization but lower cardiopulmonary arrest events; this is associated with a lower mortality rate, and improved patient safety and clinical outcomes. We recommend the widespread use of MEWS to improve patient outcomes.
authors.affiliation: Department of Medicine, Easton Hospital, Drexel University College of Medicine, Easton, PA, USA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Mathukia
authors.affiliation: Department of Medicine, Easton Hospital, Drexel University College of Medicine, Easton, PA, USA.
authors.forename: WuQiang
authors.initials: W
authors.lastname: Fan
authors.affiliation: Department of Medicine, Easton Hospital, Drexel University College of Medicine, Easton, PA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Vadyak
authors.affiliation: Department of Medicine, Easton Hospital, Drexel University College of Medicine, Easton, PA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Biege
authors.affiliation: Department of Medicine, Easton Hospital, Drexel University College of Medicine, Easton, PA, USA; mahesh_krishnamurthy@chs.net.
authors.forename: Mahesh
authors.initials: M
authors.lastname: Krishnamurthy
keywords: Modified Early Warning System; mortality; patient safety; rapid response system
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