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

J Eval Clin Pract. 2005 Apr;11(2):133-8. doi: 10.1111/j.1365-2753.2005.00513.x.


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.

MeSH terms

  • Aged
  • Critical Care*
  • Data Collection / methods
  • Hospital Information Systems*
  • Hospital Mortality
  • Humans
  • Management Audit / methods*
  • Medical Records Systems, Computerized*
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Risk Assessment / methods*
  • Severity of Illness Index*
  • United Kingdom / epidemiology