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Effectiveness of Implementing Modified Early Warning System and Rapid Response Team for General Ward Inpatients

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Abstract

This retrospective study assessed the effectiveness and impact of implementing a Modified Early Warning System (MEWS) and Rapid Response Team (RRT) for inpatients admitted to the general ward (GW) of a medical center. This study included all inpatients who stayed in GWs from Jan. 2017 to Feb. 2022. We divided inpatients into GWnon-MEWS and GWMEWS groups according to MEWS and RRT implementation in Aug. 2019. The primary outcome, unexpected deterioration, was defined by unplanned admission to intensive care units. We defined the detection performance and effectiveness of MEWS according to if a warning occurred within 24 h before the unplanned ICU admission. There were 129,039 inpatients included in this study, comprising 58,106 GWnon-MEWS and 71,023 GWMEWS. The numbers of inpatients who underwent an unplanned ICU admission in GWnon-MEWS and GWMEWS were 488 (.84%) and 468 (.66%), respectively, indicating that the implementation significantly reduced unexpected deterioration (p < .0001). Besides, 1,551,525 times MEWS assessments were executed for the GWMEWS. The sensitivity, specificity, positive predicted value, and negative predicted value of the MEWS were 29.9%, 98.7%, 7.09%, and 99.76%, respectively. A total of 1,568 warning signs accurately occurred within the 24 h before an unplanned ICU admission. Among them, 428 (27.3%) met the criteria for automatically calling RRT, and 1,140 signs necessitated the nursing staff to decide if they needed to call RRT. Implementing MEWS and RRT increases nursing staff's monitoring and interventions and reduces unplanned ICU admissions.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Medical Quality Center, Chung Shan Medical University Hospital, Taichung, Taiwan

    Wen-Jinn Liaw & Chiao-Shan Chen

  2. College of Medicine, Chung Shan Medical University, Taichung, Taiwan

    Wen-Jinn Liaw & Ming-Che Tsai

  3. Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Wen-Jinn Liaw

  4. Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan

    Tzu-Jung Wu & Li-Hua Huang

  5. Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan

    Ming-Che Tsai

  6. Artificial Intelligence Center, Chung Shan Medical University Hospital, Taichung, Taiwan

    I-Chen Lin, Yi-Han Liao & Wei-Chih Shen

  7. Department of Medical Informatics, Chung Shan Medical University, Taichung, Taiwan

    Wei-Chih Shen

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  1. Wen-Jinn Liaw
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Contributions

WJ Liaw, TJ Wu, and WC Shen conceived and designed the study. LH Huang, CS Chen, IC Lin, and YH Liao collected and interpreted the clinical data. YL Liao and WC Shen performed the statistical analysis. WJ Liaw, WC Shen, YH Liao, and MC Tsai wrote the manuscript. Finally, WJ Liaw and WC Shen made critical revisions.

Corresponding author

Correspondence to Wei-Chih Shen.

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Informed consent

This study was approved by the Institutional Review Board of Chung Shan Medical University Hospital (Date: Feb. 8, 2023/No.CS1-22196). Written, informed consent was waived for this retrospective analysis.

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The authors declare no conflict of interest.

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Liaw, WJ., Wu, TJ., Huang, LH. et al. Effectiveness of Implementing Modified Early Warning System and Rapid Response Team for General Ward Inpatients. J Med Syst 48, 35 (2024). https://doi.org/10.1007/s10916-024-02046-2

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