Electronic Modified Early Warning Score (eMEWS)...
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Patients may develop rapid and significant clinical deterioration in an unpredictable manner. Early warning scoring systems, such as the modified early warning score (MEWS) have been developed to assist with timely identification of a patient’s clinical deterioration. Literature suggests that MEWS systems reduce the number of cardiac arrest events on medical–surgical floors and facilitate identification of patients that require escalation of care and/or transfer to an Intensive Care Unit. Typically, MEWS systems are implemented on paper, using manual calculations based on recording physiologic variables outside of the routine workflow, leading to time and accuracy considerations. Patients with an elevated early warning score are more likely to be transferred to an Intensive Care Unit and less likely to die during hospitalization after eMEWS alerting was turned on in the EHR. In addition, a decrease in the number of cardiac arrest events occurring on the hospital floors has been seen after the implementation of eMEWS. Modified Early Warning Scoring Systems assist in the detection of patients at risk for clinical deterioration. Embedded within the workflow of the bedside clinician, eMEWS generates real time alerts from physiologic data captured at the point of care, triggering appropriate monitoring and escalation of care. Observations Findings Electronic Modified Early Warning Score (eMEWS) Triggers Appropriate Monitoring and Care Escalation Kevin R. Bock, MD, Michael I. Oppenheim, MD, Office of the Chief Information Officer North Shore-Long Island Jewish Health System An enterprise governance group reviewed relevant literature and selected a Modified Early Warning Scoring System for our health system. Based upon this model, an automated electronic MEWS (eMEWS) logic module was developed within our inpatient electronic health record (EHR). To calibrate eMEWS, the logic module was placed into the EHR in a ‘silent’ mode for four months. Analysis of patient outcomes (e.g. transfer to Intensive Care Unit, death) was performed to determine appropriate notification and care escalation thresholds. An extensive education program was developed for nursing, allied health, and providers. Implementation of eMEWS occurred over a three month period in a staged rollout fashion. Intervention Background Timeline 2010 • Health System Enterprise Task Force assembled • First health system hospital goes live on paper based MEWS 2011 • Development of MEWS logic module for system-wide EHR begins • Two additional system hospitals go live on paper based MEWS 2012 • eMEWS logic module deployed in EHR without clinician notification (silent mode) • Staged rollout of eMEWS notification across two tertiary care system hospitals 2013 • Data validation of eMEWS in Analytics Platform • Implementation of eMEWS in two additional health system hospitals 0 5 10 15 20 25 30 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Percentage of Patients Transferred MEWS MEWS & Transfer to ICU w/in 4 Hr Pre Alerting (Silent) Post Alerting 0 10 20 30 40 50 60 70 80 90 100 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Percentage of Patients Deceased MEWS MEWS & Death eMEWS Score Components eMEWS Algorithm 3 2 1 0 1 2 3 Systolic BP < 70 71 80 81 100 101 199 >= 200 Heart Rate < 40 41 50 51 100 101 110 110 129 >=130 Resp Rate <9 9 14 15 20 21 29 >= 30 Temperature < 35 35 38.4 >=38.5 Neuro Status Alert React Voice React Pain Unresponsive BMI < 18.5 25.1 34.9 > 35 Age 65 74 75 84 >=85 • MEWS 7 = Increase Vital Sign Frequency to Q 2 HR or shorter frequency if already Q 2 HR • MEWS 8 = Licensed Independent Provider Evaluation • MEWS 9 = Consider Rapid Response Team Evaluation • MEWS 10 and higher = Consider Change in Level of Care (e.g. ICU transfer) 0 5 10 15 20 25 30 Number of Cardiac Arrests Floor Cardiac Arrests by Month Cardiac Arrests Average UCL eMEWS p < 0.05
Transcript of Electronic Modified Early Warning Score (eMEWS)...
Patients may develop rapid and significant clinical deterioration in an unpredictable manner. Early warning scoring systems, such as the modified early warning score (MEWS) have been developed to assist with timely identification of a patient’s clinical deterioration. Literature suggests that MEWS systems reduce the number of cardiac arrest events on medical–surgical floors and facilitate identification of patients that require escalation of care and/or transfer to an Intensive Care Unit. Typically, MEWS systems are implemented on paper, using manual calculations based on recording physiologic variables outside of the routine workflow, leading to time and accuracy considerations.
Patients with an elevated early warning score are more likely to be transferred to an Intensive Care Unit and less likely to die during hospitalization after eMEWS alerting was turned on in the EHR. In addition, a decrease in the number of cardiac arrest events occurring on the hospital floors has been seen after the implementation of eMEWS. Modified Early Warning Scoring Systems assist in the detection of patients at risk for clinical deterioration. Embedded within the workflow of the bedside clinician, eMEWS generates real time alerts from physiologic data captured at the point of care, triggering appropriate monitoring and escalation of care.
Observations
Findings
Electronic Modified Early Warning Score (eMEWS) Triggers Appropriate Monitoring and
Care Escalation Kevin R. Bock, MD, Michael I. Oppenheim, MD,
Office of the Chief Information Officer North Shore-Long Island Jewish Health System
An enterprise governance group reviewed relevant literature and selected a Modified Early Warning Scoring System for our health system. Based upon this model, an automated electronic MEWS (eMEWS) logic module was developed within our inpatient electronic health record (EHR). To calibrate eMEWS, the logic module was placed into the EHR in a ‘silent’ mode for four months. Analysis of patient outcomes (e.g. transfer to Intensive Care Unit, death) was performed to determine appropriate notification and care escalation thresholds. An extensive education program was developed for nursing, allied health, and providers. Implementation of eMEWS occurred over a three month period in a staged rollout fashion.
Intervention Background
Timeline
2010 • Health System Enterprise Task Force assembled • First health system hospital goes live on paper based
MEWS 2011
• Development of MEWS logic module for system-wide EHR begins
• Two additional system hospitals go live on paper based MEWS
2012 • eMEWS logic module deployed in EHR without clinician
notification (silent mode) • Staged rollout of eMEWS notification across two tertiary
care system hospitals 2013
• Data validation of eMEWS in Analytics Platform • Implementation of eMEWS in two additional health
system hospitals
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eMEWS Score Components
eMEWS Algorithm
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Systolic BP < 70 71 -‐ 80 81 -‐ 100 101 -‐ 199 >= 200
Heart Rate < 40 41 -‐ 50 51 -‐ 100 101 -‐ 110 110 -‐ 129 >=130
Resp Rate < 9 9 -‐ 14 15 -‐ 20 21 -‐ 29 >= 30
Temperature < 35 35 -‐ 38.4 >=38.5
Neuro Status Alert React Voice React Pain Unresponsive
BMI < 18.5 25.1 -‐ 34.9 > 35
Age 65 -‐ 74 75 -‐ 84 >=85
• MEWS 7 = Increase Vital Sign Frequency to Q 2 HR or shorter frequency if already Q 2 HR
• MEWS 8 = Licensed Independent Provider Evaluation
• MEWS 9 = Consider Rapid Response Team Evaluation
• MEWS 10 and higher = Consider Change in Level of Care (e.g. ICU transfer)
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