An eight year audit before and after the introduction of modified early warning score (MEWS) charts, of patients admitted to a tertiary referral intensive care unit after CPR

Strengths and limitations of early warning scores: A systematic review and narrative synthesis

“…23 The introduction of an outreach service and MEWS at a tertiary referral centre was associated with significant reductions in the incidence of cardiac arrest calls, the proportion of patients admitted to ICU having undergone in-hospital CPR and their inhospital mortality. 24 A large Danish prospective, non-randomized, controlled study investigated unexpected in-hospital death before and after implementation of a clinical intervention comprising systematic monitoring practice, early warning scoring, an observation chart and an algorithm for bedside management. 25 The adjusted unexpected patient mortality rate was significantly lower after the intervention (17 versus 61 per 100 adjusted patient years).…”

Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review

“…The majority of studies to determine the effectiveness of RRS are based on weak, retrospective before and after studies (Moon et al 2011, Joffe et al 2011, Howell et al 2012, Herod et al 2014). The findings from these studies and from two randomised control trials (Priestley et al 2004;MERIT et al 2005) provide contradictory evidence on the impact of RRS on cardiac arrest, unplanned ICU admission or mortality rates.…”

Part 8: Education, Implementation, and Teams

“…218 The other study demonstrated a significant difference between control wards and intervention wards (introduction of a critical care outreach service) with all patients (OR, 0.70; 95% CI, 0.50-0.97), and matched randomized patients (OR, 0.52; 95% CI, 0.32-0.85). 219 Of the 33 nonrandomized studies reporting mortality, no studies reported statistically significant worse outcomes for the intervention; 15 studies with no adjustment demonstrated no significant improvement [220][221][222][223][224][225][226][227][228][229][230][231][232][233][234] ; 6 studies with no adjustment demonstrated significant improvement [235][236][237][238][239][240] ; 1 study with no adjustment reported on rates, which improved with MET, but did not report on significance 241 ; 1 study with no adjustment demonstrated significant improvement for medical patients but not surgical patients (combined significance not reported) 242 ; 4 studies with adjustment demonstrated significant improvement both before and after adjustment 243,244,250,252 ; 2 studies with adjustment demonstrated no significant improvement both before and after adjustment 245,246 ; 2 studies with adjustment demonstrated significant improvement before adjustment but not after adjustment 247,251 ; 1 study with adjustment demonstrated significant improvement before adjustment but not after adjustment 27 ; 1 study that reported on both unexpected mortality and overall mortality showed significant improvement both before and after adjustment for unexpected mortality but no significant improvement both before and after adj...…”

“…220,221,224,225,[227][228][229][230][232][233][234][235][236][237][238][239][240][241][242][243][244][245][246][247]249,250,[253][254][255][256] For the 1 RCT, 218 no significant difference between control hospitals and intervention hospitals, both unadjusted (P=0.306; Diff, −0.208; 95% CI, −0.620 to 0.204) and adjusted (P=0.736; OR, 0.94; 95% CI, 0.79-1.13), was demonstrated. Of the 31 observational studies reporting on cardiac arrest rates, 1 before-after study using an aggregated weighted scoring system (Modified Early Warning Score [MEWS]) reported significantly higher cardiac arrest rates in MEWS bands 3 to 4 after intervention, but not in MEWS bands 0 to 2 or 5 to 15, and overall cardiac arrest rate significance was not reported 232 ; 7 studies with no adjustment demonstrated no significant improvement in cardiac arrest rates after the introduction of a MET system 224,225,[228][229][230]233,234 ; 15 studies with no adjustment demonstrated significant improvement in cardiac arrest rates after the introduction of a MET system 220,221,…”