Is Modified Early Warning Score associated with clinical outcomes of patients admitted to a university internal medicine ward?

Abstract

Objective: To assess the MEWS association with the clinical outcomes (CO) of patients admitted to an internal medicine ward (IMW) at a Brazilian university hospital (UH). Introduction:It is important to quickly identify patients with clinical deterioration, especially in wards. The health team must recognize and act before the situation becomes an adverse event. In Brazil, nurses' work to overcome performance myths and the application of standardized predictive scales for patients in wards is still limited.Design: An observational cohort study designed and developed by a registered nurse that followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.Methods: Data were collected from the IMW of a UH located in the city of São Paulo, Brazil (2017). An ROC curve was calculated to strengthen the use of a MEWS of < or ≥ 4 as a cutoff. CO of the two subgroups were compared.Results: Three hundred patients completed the study; their vital signs were recorded consecutively throughout hospitalization in the IMW. The highest MEWS value each day was considered for analysis. Scores < 4 were significantly associated with a higher probability of hospital discharge, a lower chance of transfer to the ICU, a lower total number of days of hospitalization, and a lower risk of death. Score ≥ 4 had worse CO (orotracheal intubation and cardiac monitoring), transfer to the ICU, and increased risk of death. Conclusion: Scores < 4 were associated with positive outcomes, while scores ≥ 4 were associated with negative outcomes. MEWS can help prioritize interventions, increase certainty in decision-making, and improve patient safety, especially in a teaching IMW with medical teams undergoing professional development, thereby ensuring the central role of the nursing team in Brazil. Relevance for clinical practice: MEWS aid nurses in identifying and managing patients, prioritizing interventions through assertive decision-making.

Clinical decision support tools useful for identifying sepsis risk

“…MEWS is an early warning system designed to assist nurses and providers with the early identification of patients at risk for clinical deterioration. 9,19 MEWS score data variables include heart rate, BP, temperature, level of consciousness, respiratory rate, oxygen saturation, and oxygen requirement. Each variable receives a score of 0 to 3 points depending on physiologic parameters (see MEWS guide).…”