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Removing modifications to the New Zealand Early Warning Score- does ethnicity matter? A multimethod research design

Alison M Pirret1, Lesley M Kazula2

  • 1Critical Care Complex, Middlemore Hospital, Auckland, New Zealand; School of Nursing, Massey University, Auckland, New Zealand.

Intensive & Critical Care Nursing
|November 9, 2021
PubMed
Abstract

Insights

Removing modifications to the modified New Zealand Early Warning Score (M-NZEWS) significantly reduces medical emergency team (MET) triggers, especially for Māori patients. Electronic vital sign data alone may not capture all MET activations.

Area of Science:

  • Healthcare Quality Improvement
  • Patient Safety
  • Clinical Decision Support Systems

Background:

  • Modified New Zealand Early Warning Score (M-NZEWS) modifications were previously found to increase Medical Emergency Team (MET) triggers in medical ward patients.
  • A significant disparity in M-NZEWS triggers was noted among Māori patients.

Purpose of the Study:

  • To evaluate the effect of removing M-NZEWS modifications on MET triggers in both medical and surgical wards.
  • To ascertain the correlation between M-NZEWS MET triggers, subsequent MET activations, and the accuracy of electronic vital sign data in reflecting these events.

Main Methods:

  • A multimethod research design was employed, integrating electronic vital sign data analysis with MET and critical care outreach data.
  • Phase one involved analyzing ward electronic vital sign data.
  • Phase two focused on analyzing MET and critical care outreach databases.

Main Results:

  • Removing M-NZEWS modifications would decrease patient MET triggers by 26.9%, with a disproportionately larger impact on Māori patients.
  • Less than half (45.8%) of M-NZEWS MET triggers led to MET activation; 58.9% were escalated to critical care outreach.
  • While electronic vital sign systems captured only 59.2% of MET activations, critical care outreach data confirmed M-NZEWS MET triggers as the primary cause for most activations.

Conclusions:

  • Reverting M-NZEWS to its original form substantially reduces MET triggers, particularly benefiting Māori patients.
  • Reliance solely on electronic vital sign data for tracking MET triggers and activations can be misleading, potentially underestimating the true incidence.
Keywords:
Critical care outreachMedical emergency teamNew Zealand early warning scoring systemVital signs

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