Evaluating Modified Early Warning Score Compliance to Minimize Unnecessary Intensive Care Unit Admissions: A
Mazhar Khalil1, Raza Ullah2, Haseeb Ahmad3
1Intensive Care Unit, Hayatabad Medical Complex, Peshawar, Khyber Pakhtunkhwa, Pakistan.
Background:
Intensive Care Unit (ICU) resources are scarce in low- and middle-income countries (LMICs), with a median of 0.7 beds per 100,000 population. The Modified Early Warning Score (MEWS) aids early identification of clinical deterioration and supports standardized escalation and ICU triage decisions to optimize critical-care resource use. However, adherence to MEWS protocols remains inconsistent.
Research Question:
Does adherence to MEWS-based ICU admission criteria improve patient outcomes, and which admission categories/service lines contribute most to MEWS-threshold discordance?
Methods:
We conducted a descriptive cross-sectional baseline needs assessment of 120 adult ICU admissions over 3 months at a university teaching tertiary referral centre in Pakistan. MEWS at ICU admission was compared against the prespecified admission threshold (MEWS ≥ 7) to quantify threshold compliance and to characterise sub-threshold admissions by admission category/service line. Mortality and ICU length of stay were analysed as secondary, exploratory outcomes using univariable logistic regression and correlation analyses, respectively.
Results:
Only 34.2% of ICU admissions met the prespecified MEWS threshold, while 65.8% were admitted despite sub-threshold scores, indicating substantial MEWS-threshold discordance. Discordance was most frequent in trauma-related/neurosurgical and major surgical admissions. Meeting the MEWS threshold was associated with worse survival (OR = 0.247; 95% CI: 0.111-0.548), consistent with higher illness severity among threshold-concordant admissions. This association was not adjusted for confounders due to the limited events and should be interpreted cautiously. MEWS showed minimal correlation with ICU length of stay (r = 0.05; p = 0.576).
Conclusion:
In this baseline needs assessment, ICU admissions frequently diverged from the prespecified MEWS threshold, suggesting that clinician discretion and service-line context commonly override score-based recommendations. These findings provide an institution-specific foundation for targeted quality improvement (protocol refinement, training, audit-feedback, decision support, and step-up/HDU pathways).
Related Concept Videos
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:20Rheumatic Heart Disease IV: Nursing Management
01:26Acute Coronary Syndrome V: Nursing Management
01:29Nursing Assessment
The nurse collects all aspects of the patient's health in the initial assessment, establishing priorities for ongoing focused assessments...