Effectiveness of implementing modified early warning system for inpatient in general wards of a medical center in Taiwan
Introduction
•The Modified Early Warning System ( is a well validated tool widely used to detect unexpected deterioration of hospitalized patients
•This study aimed to assess the effectiveness and impact of implementing MEWS for the inpatients who stayed in the general ward (GW).
Methods
•Adult inpatients were retrospectively included between January 2017 and February 2022 (Fig. 1).
•If MEWS score ≥ 7 points, a warning message will automatically send to notify the Rapid Response Team (RRT) members. If the score is 5 or 6 or if the scores of three vital signs are ≥1, a warning is issued, and the nursing staff visits the patient and determines whether RRT members must be notified. Buffer time and Too-early warning were defined to assessing the appropriateness of the warning time (Fig. 2).
•The primary outcome defined unplanned admission(s) to intensive care units (upaICU) as unexpected deterioration.
Results
•A total of 129,039 inpatients were included and composed of 58,106 GWnon-MEWS and 71,023 GWMEWS.
•The numbers of upaICU of GWnon-MEWS and GWMEWS were 488 (.84%) and 468 (.66%), indicating that the implementation significantly reduced the occurrence of unplanned admission to the ICU (p<.0001).
•1,551,525 times of MEWS assessments were produced for the GWMEWS; among these assessments, there were 1,525,720 assessed as true negatives for the "Normal" or "Too early" subgroups, while the remaining 3,678 were assessed as false negatives for "Buffer time". In contrast, among the 22,127 times of MEWS that met the criteria for warning, only 1,568 (7.1%) were in the interval of “Buffer time” (Table 1).
•A total of 24% of all upaICU (230/956) occurred on the first admission day and 36.3% of all upaICU occurred within the first 3 days after admission from the ED (Fig. 3).
•The contributions of each vital sign in the MEWS evaluations demonstrated the respiratory and pulse rates contributed significantly to the MEWS evaluation. (Fig. 4).
Conclusion
Implementing Modified Early Warning System (MEWS) and Rapid Response Team (RRT) increases the monitoring and intervention by nursing staff and reduces unplanned intensive care units admissions.
