title: Use of a modified early warning score system to reduce the rate of in-hospital cardiac arrest.
abstract: BACKGROUND
  Physiological abnormalities are often observed in patients prior to cardiac arrest. A modified early warning score (MEWS) system was introduced, which aims to detect early abnormalities by grading vital signs, and the present study investigated its usefulness.
  
  
  METHODS
  Based on previous reports, the Chubu Tokushukai Hospital-customized MEWS was developed in Okinawa, Japan. The MEWS was calculated among all inpatients, and the rates of in-hospital cardiac arrests (IHCAs) were compared according to the score. The warning zone (WZ) was set as 7 or more because of the high possibility of acute deterioration. The MEWS system was introduced to provide immediate interventions for patients who reached the WZ in accordance with the callout algorithm. The numbers of IHCAs were compared between the 18 months before and after introduction of the MEWS system.
  
  
  RESULTS
  The numbers of patients who experienced IHCA with each score were as follows: score of 6, 1 of 556 patients (0.18 %); score of 7, 4 of 289 (1.40 %); score of 8, 2 of 114 (1.75 %); and score of 9 or more, 2 of 56 (3.57 %). There was no significant difference in the mean age or sex between before and after the introduction of the MEWS system. The rate of IHCAs per 1000 admissions decreased significantly from 5.21 (79/15,170) to 2.05 (43/17,961) (p < 0.01).
  
  
  CONCLUSIONS
  The Chubu Tokushukai Hospital-customized MEWS was applied to all inpatients, and the rate of IHCA decreased owing to the introduction of the system, as the system enables early interventions for patients who have the possibility of acute deterioration.
authors: Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan.
authors: Isao
authors: I
authors: Nishijima
authors: Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan.
authors: Shouhei
authors: S
authors: Oyadomari
authors: Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan.
authors: Shuuto
authors: S
authors: Maedomari
authors: Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan.
authors: Risa
authors: R
authors: Toma
authors: Department of Critical Care Medicine, Chubu Tokushukai Hospital, 3-20-1, Teruya, Okinawa City, Okinawa Japan.
authors: Chisato
authors: C
authors: Igei
authors: Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Shinya
authors: S
authors: Kobata
authors: Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Jyun
authors: J
authors: Koyama
authors: Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Ryuichiro
authors: R
authors: Tomori
authors: Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Natsuki
authors: N
authors: Kawamitsu
authors: Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Yoshiki
authors: Y
authors: Yamamoto
authors: Department of Surgery, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Masafumi
authors: M
authors: Tsuchida
authors: Department of Internal Medicine, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Yoshihiro
authors: Y
authors: Tokeshi
authors: Department of Surgery, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Ryo
authors: R
authors: Ikemura
authors: Department of Surgery, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Kazufumi
authors: K
authors: Miyagi
authors: Department of Neurosurgery, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Koichi
authors: K
authors: Okiyama
authors: Department of Surgery, Chubu Tokushukai Hospital, Okinawa, Japan.
authors: Kiyoshi
authors: K
authors: Iha