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Implementation of the Modified Early Warning Score (MEWS) in a Community Hospital FREE TO VIEW

Benjamin Wykes, MD; Syed Ahmed; Sacha Dubois, MPH; Alisha Tessier, MD; Michael Niebergall, MD; Rosemarie Bava; Julie Mongeau Mongeau
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Northern Ontario School of Medicine, Thunder Bay, ON, Canada

Chest. 2015;148(4_MeetingAbstracts):485A. doi:10.1378/chest.2280079
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SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Use of the Modified Early Warning Score (MEWS) has been shown to reduce the number of Code Blue events outside of the ICU in centres without an ICU outreach service. MEWS has not been studied in the setting of a smaller community hospital with an established outreach service.

METHODS: A prospective cohort (n=8,828) consisting of all patients on medical and surgical wards (excluding pediatrics, palliative care, labour & delivery and mental health) for one year had their vital signs tracked in the EMR (MEWS score automatically calculated). Scores > 5 resulted in the activation of the Medical Emergency Team (MET) in addition to the activation criteria already in place, while scores of 3 and 4 increased the frequency of vital sign monitoring and the most responsible physician was informed. The control (pre-MEWS) group (n=8,802) was a historical cohort of patients admitted to the study wards during the year preceding MEWS implementation. We calculated adjusted odds ratios of 30 day in-hospital mortality for MEWS > 5 by cohort controlling for sex and age. To ensure independence repeated visits were removed.

RESULTS: Compared to the pre-MEWS cohort, the prospective cohort had a lower mean age (55.7 vs 62.4, t[17,628]=21.9,p < .0001) and a greater proportion of female patients (59.8% vs 51.8%, c2(1)=113.2, p < .0001). A total of 159 (1.8%) and 182 (2.1%) deaths occurred in the prospective and pre-MEWS cohorts respectively. A MEWS score > 5 (vs. < 5) increased the adjusted odds of dying by eight times in the prospective cohort (OR: 8.2; 95% CI: 6.1, 11.2) and 11 times (OR: 11.0, 95% CI: 6.1, 19.8) in the pre-MEWS cohort. However the odds of dying did not statistically differ by cohort (Wald[1]=.74, p=0.39).

CONCLUSIONS: Implementation of MEWS as an additional activation criterion for an ICU outreach service did not improve 30 day in-hospital mortality.

CLINICAL IMPLICATIONS: Use of aggregate weighted track-and-trigger systems, although more sensitive than single parameter track-and-trigger systems, does not improve in-hospital mortality in community hospitals with an established ICU outreach service

DISCLOSURE: The following authors have nothing to disclose: Benjamin Wykes, Syed Ahmed, Sacha Dubois, Alisha Tessier, Michael Niebergall, Rosemarie Bava, Julie Mongeau Mongeau

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