A tertiary care centre experience of modified early warning score (MEWS) in post-operative patients

Authors

  • Umesh Raj Somasundaram Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Kanchipuram, India
  • Esakki Santhiyagappan Department of General Surgery, Melmaruvathur Adhiparasakthi Institute of Medical Sciences and Research, Melmaruvathur, Kanchipuram, India

DOI:

https://doi.org/10.18203/2349-2902.isj20184618

Keywords:

Modified early warning score, Major procedure, SICU, P.O period

Abstract

Background: The aim of the study is to analyse and implement the modified early warning score (MEWS) in assessment of need of early intervention and surgical intensive care unit (SICU) admission in patients undergoing elective and emergency major surgical procedures.

Methods: This prospective study was done in Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu. It included 150 patients who underwent major emergency and elective surgical procedures under regional or general anaesthesia with monitoring of physiological parameters in the P.O period.

Results: The predictability of MEWS system was analyzed with the following results: MEWS 1=77 patients were alive (51.3%) of the study population. MEWS 8=3 patients were alive (2.1%) and 7 patients died (100%) of the study population. This indicates that the greater MEWS the mortality of the patient rises, and the lesser MEWS score the chances of mortality in the P.O period is very minimal. In our study, we have derived that MEWS score of 7 or 8 implicates the need for SICU admission and it indicates an increased mortality of the patient in the P.O period.

Conclusions: The Modified Early Warning Score (MEWS) is an effective tool in identifying the early deterioration of the patients undergoing major surgical procedures and assessing the need for admission in SICU for further interventions.

References

McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, et al. Confidential inquiry into quality of care before admission to intensive care. BMJ. 1998;316:1853-8.

Andrews T, Waterman H. Packaging: a grounded theory of how to report physiological deterioration effectively. J Adv Nurs. 2005;52(5):473-81.

Coughlan E, Geary U, Wakai A, O'Sullivan R, Browne J, McAuliffe E, et al. An introduction to the Emergency Department Adult Clinical Escalation protocol: ED-ACE. Emerg Med J. 2017;34(9):608-12.

Hands C, Reid E, Meredith P, Smith GB, Prytherch DR, Schmidt PE. Patterns in the recording of vital signs and early warning scores: compliance with a clinical escalation protocol. BMJ Qual Saf. 2013;22(9):719-26.

Odell M, Forster A, Rudman K, Bass F. The critical care outreach service and the early warning system on surgical wards. Nurs Crit Care. 2002;7(3):132-5.

Hogan, Jacqueline. Why don't nurses monitor the R. Rs of patients? Br J Nursing. 2006 ;15(9):489-92.

Leuvan CH, Mitchell I. Missed opportunities? An observational study of vital sign measurements. Crit Care Resusc. 2008;10(2):111-5.

Donohue LA, Endacott R. Track, trigger and teamwork: communication of deterioration in acute medical and surgical wards. Intensive Crit Care Nurs. 2010;26(1):10-7.

Cooper RJ, Schriger DL, Flaherty HL, Lin EJ, Hubbell KA. Effect of vital signs on triage decisions. Ann Emerg Med. 2002;39(3):223-32.

Endacott R, Kidd T, Chaboyer W, Edington J. Recognition and communication of patient deterioration in a regional hospital: a multimethods study. Aust Crit Care. 2007;20:100-5.

Ludikhuize J, Smorenburg SM, de Rooij SE, de Jonge E. Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score. J Crit Care. 2012;27(4):424.e7-13.

Prytherch DR, Smith GB, Schmidt P, Featherstone PI, Stewart K, Knight D. Calculating early warning scores-a classroom comparison of pen and paper and hand-held computer methods. Resuscitation. 2006;70(2):173-8.

Cuthbertson BH. Optimising early warning scoring systems. Resuscitation. 2008;77(2):153-4.

Smith GB, Prytherch DR, Schmidt PE, Featherstone PI. Review and performance evaluation of aggregate weighted 'track and trigger' systems. Resuscitation.2008;77(2):170-9.

Hammond NE, Spooner AJ, Barnett AG, Corley A, Brown P, Fraser JF. The effect of implementing a modified early warning scoring (MEWS) system on the adequacy of vital sign documentation. Aust Crit Care. 2013;26(1):18-22.

Kellett J, Kim A. Validation of an abbreviated Vitalpac Early Warning Score (ViEWS) in 75,419 consecutive admissions to a Canadian regional hospital. Resuscitation. 2012;83(3):297-302.

Kruisselbrink R, Kwizera A, Crowther M, Fox-Robichaud A, O'Shea T, Nakibuuka J, et al. Modified early warning score (MEWS) identifies critical illness among ward patients in a resource restricted setting in Kampala, Uganda: a prospective observational study. PLoS One. 2016;11:e0151408.

Mathukia C, Fan W, Vadyak K, Biege C, Krishnamurthy M. Modified Early Warning System improves patient safety and clinical outcomes in an academic community hospital. J Community Hospital Internal Medicine Perspectives. 2015;5(2):26716.

Gardner-Thorpe J, Love N, Wrightson J, Walsh S, Keeling N. Ann R Coll Surg Eng. 2006;88(6):571-5.

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Published

2018-10-26

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Original Research Articles