Use of a modified early warning score system to reduce the rate of in-hospital cardiac arrest

Abstract

BackgroundPhysiological abnormalities are often observed in patients prior to cardiac arrest. A modified early warning score (MEWS) system was introduced, which aims to detect early abnormalities by grading vital signs, and the present study investigated its usefulness.MethodsBased on previous reports, the Chubu Tokushukai Hospital-customized MEWS was developed in Okinawa, Japan. The MEWS was calculated among all inpatients, and the rates of in-hospital cardiac arrests (IHCAs) were compared according to the score. The warning zone (WZ) was set as 7 or more because of the high possibility of acute deterioration. The MEWS system was introduced to provide immediate interventions for patients who reached the WZ in accordance with the callout algorithm. The numbers of IHCAs were compared between the 18 months before and after introduction of the MEWS system.ResultsThe numbers of patients who experienced IHCA with each score were as follows: score of 6, 1 of 556 patients (0.18 %); score of 7, 4 of 289 (1.40 %); score of 8, 2 of 114 (1.75 %); and score of 9 or more, 2 of 56 (3.57 %). There was no significant difference in the mean age or sex between before and after the introduction of the MEWS system. The rate of IHCAs per 1000 admissions decreased significantly from 5.21 (79/15,170) to 2.05 (43/17,961) (p < 0.01).ConclusionsThe Chubu Tokushukai Hospital-customized MEWS was applied to all inpatients, and the rate of IHCA decreased owing to the introduction of the system, as the system enables early interventions for patients who have the possibility of acute deterioration.

Application Progress of Modified Early Warning Score in General Departments

“…When the total score reached 7, nurses and doctors conducted relevant treatment. The results confirmed that MEWS can effectively reduce the rate of cardiac arrest in inpatients [17]. There are few general departments applying MEWS in China, and most of them focus on the studies of single department [18] [19] or single disease [20] [21], such as the use of MEWS in cardiology, and the application value of MEWS in cardiac arrest patients, etc.…”

“…Dynamic MEWS score can better reflect patients' conditions in real time [8]. Nishjima once evaluated the MEWS once a day for all patients in the general department, the corresponding physiological indicators recorded into the nursing system, by the system automatically calculate the MEWS score, when reached 7 points, the system automatically alarm, ward nurses need to report the attending doctor, for the treatment of patients, during which continue to evaluate three times a day, if discover the patients need a higher level of medical care facilities, are immediately turned to ICU, unless the patient give up treatment agreement (Do Not Resuscitate, DNR) [17]. Most domestic studies have studied the degree of prediction of disease changes in patients with a certain static MEWS score, with the most related studies on single score at admission [22].…”

Gambaran Acute Physiologic and Chronic Health Evaluation (APACHE) II, Lama Perawatan, dan Luaran Pasien di Ruang Perawatan Intensif Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung pada Tahun 2017

“…Intervensi yang baik pada pasien yang mengalami emergensi medik di ruangan dan monitoring ketat pada pasien yang menunjukkan gejala emergensi medik secara dini akan menurunkan skor rerata APACHE II pada pasien ICU dengan asal admisi ruangan. 9 Rerata lama perawatan di ICU RSUP Dr. Hasan Sadikin Bandung adalah 9,89 hari. Faktor yang memengaruhi lama perawatan adalah faktor institusi, faktor medis, faktor sosial, dan faktor psikologis.…”

Potential roles of the wearable cardioverter-defibrillator in acute phase care of patients at high risk of sudden cardiac death: A single-center Japanese experience

“…However, it was reported that in 358 American hospitals, the total number of in-hospital cardiac arrests (IHCA) was 102,153, and the number of IHCA cases per 1000 admissions was 4.02 (IQR 2.95-5.65), and the most important factor to improve case-survival rate was a hospital's nurse-to-bed ratio [14]. Furthermore, in Japan, Nishijima reported the incidence of IHCA before and after introduction of the modified early warning score (MEWS) [15]. Although the incidence of IHCA was significantly decreased after introduction of the MEWS system (before the introduction of the MEWS system, 5.21%/15months versus after introduction, 2.39%/15 months; p < 0.01), the risk of IHCA remained.…”