Use of a patient information system to audit the introduction of modified early warning scoring

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Abstract
Modified early warning scoring (MEWS) uses abnormalities in routine observations to identify patients at risk of critical illness. Nurses recorded scores at or above the medical response score of 3 on a hospital clinical information system during the first year of introducing MEWS to 10 wards in a university hospital. A total of 619 triggers were recorded in 365 patients. Fifty-nine required intensive care unit (ICU)/high dependency unit (HDU) care; 71 died. Survival was significantly worse for initial scores > 4 (35/104 patients died) than for scores 3–4 (P < 0.004). Multivariant analysis showed age (P < 0.001) and trigger score (P < 0.001) but not ward specialty (P = 0.1) predicted death. Mean ages of survivors and non-survivors were 64 years (SD 18) and 74 years (SD 17), respectively. Addition of a score for age did not significantly increase the area under a receiver operator characteristic curve for the predictive value of MEWS scores. The study shows that increasing MEWS score is associated with worse outcome across a range of specialties and that nursing staff will use a patient information system to audit MEWS scores.