Use of Modified Early Warning Scores by a Rapid Response Team for the Purpose of Code Reduction in the Non‐ICU Patient Population

1Northwestern Memorial Hospital, Chicago, IL
2Northwestern Memorial Hospital, Chicago, IL
3Northwestern Memorial Hospital, Chicago, IL

Meeting: Hospital Medicine 2009, May 14-17, Chicago, Ill.

Abstract number: 123


Current research supports the fact that early recognition of vital sign deterioration provides the opportunity for early intervention and subsequent reduction of cardiac and respiratory arrest risk for non‐ICU patients. MEWS, or Modified Early Warning Score, is a physiological scoring system that assigns risk for clinical deterioration based on vital signs and clinical observation.


As part of a quality improvement project, critical care nurses on an academic medical center's RRT used MEWS and vital sign surveillance to assess non‐ICU patients and to provide early intervention in the presence of deteriorating patient clinical assessment. An electronic MEWS scoring patients based on vital sign data entered into Cerner's PowerChart® was developed to assist rapid response team (RRT) nurses in their proactive identification of at‐risk patients.


The MEWS was integrated into Northwestern Memorial Hospital's RRT activation scheme in December 2006 with a pilot study. Prior to MEWS integration, RRT could be activated by NMH personnel and by the RRT nurses themselves as they made rounds on the floors or visiting patients within the first 24 hours of their transfer out of ICU. The MEWS became the third trigger for RRT activation. A MEWS of 5 or more identified at‐risk patients. The RRT nurse evaluated each at‐risk patient for preventive interventions by initiating a brief RRT plan of care. More extensive interventions were performed based on patient status at the time of RRT assessment.


Quality improvement project analyses showed higher MEWS associated with (a) patients who later transferred to higher levels of care and (b) patients who experienced cardiac and respiratory emergency situations. Additionally, retrospective arrest audits were conducted by the RRT nurses to identify information for process analysis and to guide future patient care. Results from a sample of 368 patients revealed that the RRT nurses intervened with the plan of care for 60% of non‐ICU patients, facilitated early proactive transfer to higher level of care for 4% of patients, and provided other interventions for 15% of patients. An initial 21% reduction in average number of preventable codes per 1000 patient‐days has been achieved since the implementation of the electronic MEWS, and on average an additional 170 patients per month are seen by the RRT RN each month. The MEWS risk assessment assists RRT nurses to quickly identify patients at risk and to provide care at the onset of clinical decline. Code events in general care areas have decreased as a result of using the MEWS. Future use of MEWS risk assessment by primary care nurses will be explored as a means to further reduce the number of cardiac and respiratory emergencies.

Author Disclosure:

S. D. Miller, none; M. P. Gaffney, none; L. M. Michna, none.

To cite this abstract:

Miller S, Gaffney M, Michna L. Use of Modified Early Warning Scores by a Rapid Response Team for the Purpose of Code Reduction in the Non‐ICU Patient Population. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 123. Journal of Hospital Medicine. 2009; 4 (suppl 1). Accessed March 28, 2020.

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