Standardized measurement of the Modified Early Warning Score results in enhanced implementation of a Rapid Response System: A quasi-experimental study

Ludikhuize, Jeroen; Borgert, Marjon; Binnekade, Jan M.; Subbe, Christian P; Dongelmans, Dave A.; Goossens, Astrid

doi:10.1016/j.resuscitation.2014.02.009

Cited by 64 publications

(38 citation statements)

References 38 publications

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“…Early warning scores (EWS) are physiological track-and-trigger systems, which use a multiparameter or aggregate weighted scoring system that assists in detecting physiological changes and thereby identify patients at risk for further deterioration [2,3]. The modified early warning score (MEWS) is a commonly used and validated EWS system (see Multimedia Appendix 1) [4-6]. A higher MEWS is associated with admissions to the intensive care unit (ICU), cardiac arrest, and mortality [7-9].…”

Section: Introductionmentioning

confidence: 99%

Continuous Monitoring of Vital Signs Using Wearable Devices on the General Ward: Pilot Study

Weenk

Goor

Frietman

et al. 2017

JMIR Mhealth Uhealth

181

160

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BackgroundMeasurement of vital signs in hospitalized patients is necessary to assess the clinical situation of the patient. Early warning scores (EWS), such as the modified early warning score (MEWS), are generally calculated 3 times a day, but these may not capture early deterioration. A delay in diagnosing deterioration is associated with increased mortality. Continuous monitoring with wearable devices might detect clinical deterioration at an earlier stage, which allows clinicians to take corrective actions.ObjectiveIn this pilot study, the feasibility of continuous monitoring using the ViSi Mobile (VM; Sotera Wireless) and HealthPatch (HP; Vital Connect) was tested, and the experiences of patients and nurses were collected.MethodsIn this feasibility study, 20 patients at the internal medicine and surgical ward were monitored with VM and HP simultaneously for 2 to 3 days. Technical problems were analyzed. Vital sign measurements by nurses were taken as reference and compared with vital signs measured by both devices. Patient and nurse experiences were obtained by semistructured interviews.ResultsIn total, 86 out of 120 MEWS measurements were used for the analysis. Vital sign measurements by VM and HP were generally consistent with nurse measurements. In 15% (N=13) and 27% (N=23) of the VM and HP cases respectively, clinically relevant differences in MEWS were found based on inconsistent respiratory rate registrations. Connection failure was recognized as a predominant VM artifact (70%). Over 50% of all HP artifacts had an unknown cause, were self-limiting, and never took longer than 1 hour. The majority of patients, relatives, and nurses were positive about VM and HP.ConclusionsBoth VM and HP are promising for continuously monitoring vital signs in hospitalized patients, if the frequency and duration of artifacts are reduced. The devices were well received and comfortable for most patients.

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Section: Introductionmentioning

confidence: 99%

Continuous Monitoring of Vital Signs Using Wearable Devices on the General Ward: Pilot Study

Weenk

Goor

Frietman

et al. 2017

JMIR Mhealth Uhealth

181

160

View full text Add to dashboard Cite

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“…Five of the eight IM studies measuring unplanned transfers to ICU or critical care reported no significant impact on transfer rates following intervention, including a very large study where ICU transfers remained constant in the intervention and control periods (32). In contrast, three large IM studies found significant reductions in transfers to ICU of at least 50% (34,37,41).…”

Section: Icu Transfersmentioning

confidence: 99%

“…Short follow-up times precluded sufficient numbers of outcome events of interest after the intervention to detect significant differences. Some monitored only for 24 h from admission or from the time of a procedure (41,(45)(46)(47). The likelihood of underestimating adverse event rates is high if LOS was below 2 days.…”

Section: Intermittent Monitoringmentioning

confidence: 99%

Effectiveness of continuous or intermittent vital signs monitoring in preventing adverse events on general wards: a systematic review and meta-analysis

et al. 2016

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This review of heterogeneous monitoring approaches found no conclusive confirmation of improvements in prevention of cardiac arrest, reduction in length of hospital stay, or prevention of other neurological or cardiovascular adverse events. The evidence found to date is insufficient to recommend continuous vital signs monitoring in general wards as routine practice. Future evaluations of effectiveness need to be undertaken with more rigorous methods and homogeneous outcome measurements.

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“…23 Some studies employ MEWS to classify internal medicine patients at admission, [24][25][26] but some others highlight the need for improvement and extension of parameters to better classify these patients. 23,27,28 Much effort has recently been put by the UK National Health Service (NHS) into a standardized scoring system and, as a result, the national early warning score (NEWS) has been introduced. 11 The NEWS, which adds O 2 saturation to MEWS parameters, has shown its superiority in detecting clinical deterioration even if the positive impact on patient safety remains to be investigated.…”

Section: Discussionmentioning

confidence: 99%

The Niguarda MEWS, a new and refined tool to determine criticality and instability in Internal Medicine Ward and Emergency Medicine Unit

et al. 2017

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This study compares the effect of the modified early warning score (MEWS) versus a new early warning system (Niguarda MEWS) for detecting instability and criticality in hospital medical departments. A retrospective observational study was conducted in the Internal Medicine ward of Niguarda Ca' Granda Hospital in Milan between November 2013 and October 2014. MEWS and Niguarda-MEWS were gathered using: systolic blood pressure, respiratory frequency, heart rate, temperature, level of consciousness, oxygen saturation, creatinine level, hematocrit level and age. In order to determine if the patient was critical or not the MEWS criticality cut-off value chosen was 3, while in the Niguarda MEWS it was 6. The primary outcome was the correlation between the critical level of the two scores and in-hospital mortality. The secondary endpoint was the correlation between a specific disease and the two scores. In the study, 471 patients were included, using both the MEWS and the Niguarda MEWS score at admittance: 33.4% of patients turned out to be critically ill using the former, 40.98% when using the latter. Therefore, the specificity of scores was 70% for MEWS and 73% for Niguarda MEWS, the sensitivity 58% for MEWS and 63% for Niguarda MEWS, Niguarda MEWS area under the curve (AUC): 0.736, MEWS AUC: 0.670. For the secondary outcome, the new score is higher for genitourinary and respiratory diseases. Niguarda-MEWS could be an optimal tool to detect criticality and instability in order to address the patient to the right level of care.

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Standardized measurement of the Modified Early Warning Score results in enhanced implementation of a Rapid Response System: A quasi-experimental study

Cited by 64 publications

References 38 publications

Continuous Monitoring of Vital Signs Using Wearable Devices on the General Ward: Pilot Study

Continuous Monitoring of Vital Signs Using Wearable Devices on the General Ward: Pilot Study

Effectiveness of continuous or intermittent vital signs monitoring in preventing adverse events on general wards: a systematic review and meta-analysis

The Niguarda MEWS, a new and refined tool to determine criticality and instability in Internal Medicine Ward and Emergency Medicine Unit

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