2018 Research Forum

The Modified Early Warning System (MEWS) versus the 10 Signs of Vitality (10SOV): A comparison of two scoring tools to identify at-risk patients of clinical deterioration.

Presenter: Juan Arhancet DO Principal Investigator: Vicken Totten MD Faculty Sponsor: Linda L Herma MD

Juan Arhancet DO 1 , Sean Oldroyd DO 2, Frank Sebat MD FCCM 3 , Vicken Totten MD 4 , Mary Anne Vandegrift RN MSN PHN 5 All affiliations are with the Kaweah Delta Health Care District, Emergency Medicine Department, unless otherwise noted. 1 Resident Physician R4 2 Associate Program Director, Emergency Medicine Residency Program; Medical Director, Stroke Program 3 Associate Faculty, Department of Internal Medicine, Division of Critical Care, Mercy Medical Center, Redding, CA; Director, Kritikus Foundation 4 Associate Faculty, Emergency Medicine Residency Program 5 Quality Improvement Specialist - Quality & Patient Safety Department; RN Clinical Research Coordinator; Interim Chair, Institutional Review Board INTRODUCTION Almost all hospitalized adults receive nursing care on the general medical-surgical floor during their stay. Observational studies have demonstrated that these admitted patients show physiologic signs of clinical deterioration as early as 24-hours prior to a serious clinical event that would require intervention. Deterioration is often presaged by abnormalities in various vital signs such as, respiratory rate (RR), oxygenation (O2), heart rate (HR), and mental status (MS), leading to increased morbidity and even mortality. In order to assist staff to notice the earliest signs of deterioration, scoring tools have been devised for acute-care hospitals as a way to detect which patients are at highest risk. The Modified Early Warning System (MEWS) is one such commonly used algorithm that is well studied and used by many hospitals. A different scoring tool, called the 10 Signs of Vitality (10SOV), is another. This study will utilize our hospital database to compare the two warning tools and to explore how each one performs at detecting early signs of deterioration. PURPOSE This process of early detection of patient deterioration followed by timely medical intervention is important for improving patient outcome. If one arm is afferent, the detection, and the other arm is the efferent, the RRT, this paper will focus on the efferent arm of the process in the hope of elucidating which scoring system is best at predicting at-risk patients. METHOD An observational before and after comparison of outcomes in a 450 bed community hospital comparing the MEWS and the 10SOV. A total number of 1471 floor patients were observed between 2013 and 2016 and data for both MEWS and 10SOV were collected for each patient. A one-way ANOVA was conducted to determine whether adult patients (greater than 18 years old) admitted from the Emergency Department that received an RRT activation within 24 hours of admission to the medical/surgical floor, or intermediate care unit (ICCU), were transferred to the ICU within 24 hours of admission compared to those who did not receive an RRT within 24 hours.

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