Effectiveness of Implementing Modified Early Warning System and Rapid Response Team for General Ward Inpatients

Area of Science:

• Medical Science
• Clinical Practice
• Patient Safety

Background:

• Unplanned intensive care unit (ICU) admissions indicate patient deterioration on general wards.
• Early detection systems are crucial for timely medical intervention and improved patient outcomes.
• The integration of Modified Early Warning Systems (MEWS) and Rapid Response Teams (RRT) aims to address these challenges.

Purpose of the Study:

• To evaluate the effectiveness of implementing MEWS and RRT in reducing unexpected patient deterioration on general wards.
• To assess the impact of MEWS and RRT on unplanned ICU admissions.
• To analyze the detection performance and clinical utility of MEWS.

Main Methods:

• A retrospective study design comparing inpatients before and after MEWS/RRT implementation (Jan. 2017 - Feb. 2022).
• Inpatients were divided into non-MEWS and MEWS groups based on system implementation in Aug. 2019.
• Primary outcome: unplanned ICU admission; secondary outcomes: MEWS detection performance (sensitivity, specificity, PPV, NPV) and RRT activation criteria.

Main Results:

• The MEWS group showed a significant reduction in unplanned ICU admissions (0.66%) compared to the non-MEWS group (0.84%) (p < .0001).
• MEWS demonstrated high specificity (98.7%) and negative predictive value (99.76%) in detecting deterioration within 24 hours of unplanned ICU admission.
• A total of 1,568 warning signs were recorded, with 27.3% automatically triggering RRT and the remainder requiring nursing staff assessment.

Conclusions:

• Implementation of MEWS and RRT significantly decreases unplanned ICU admissions in general wards.
• MEWS serves as an effective tool for early detection of patient deterioration, enhancing nursing staff's monitoring and intervention capabilities.
• The combined MEWS and RRT approach improves patient safety and clinical outcomes on general hospital wards.