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New Alert System Sees Small Changes in Vital Signs

A new system designed to identify at-risk patients by detecting subtle changes in vital signs is being evaluated in the Med-Surg units starting this month.

The Modified Early Warning System (MEWS) is being implemented as a test of change on 4 Northwest, 5 Southeast and 7 North; it is expected to go live in Med-Surg this summer. This initiative is being sponsored by the Cedars-Sinai Medicine Best Practice Team and Department of Nursing.

MEWS is not specific to a diagnosis or a clinical condition, and it uses an algorithm that calculates a score based on five widely measured clinical parameters: heart rate, respiratory rate, systolic blood pressure, temperature and oxygen saturation in the blood.

Higher scores are associated with more serious clinical changes (see table below). Cedars-Sinai is using the ability of CS-Link™ to calculate the MEWS score automatically when vital signs are uploaded to the electronic medical record.

Elevated MEWS scores will trigger CS-Link alerts to nursing staff. Moderately elevated scores beginning at 3 will prompt more frequent monitoring of vital signs. At scores of 4-5, interventions include notifying the primary care physician. At 6, a Rapid Response Team (RRT) is alerted.

MEWS has been used successfully by other healthcare organizations to help identify patients beginning to fail due to a variety of medical conditions, including sepsis.

MEWS will be employed initially at Cedars-Sinai as a tool to help decrease mortality in septic inpatients by calling attention to subtle changes in vital signs that can help prompt early intervention, such as more frequent monitoring, fluid resuscitation, timely ordering and administration of antibiotics, ordering of lab tests, assessment by a crisis nurse and calling an RRT.

In addition to using CS-Link technology to calculate the MEWS score, CS-Link will provide alerts for interventions based on the MEWS score and will prompt use of the sepsis order set.

Sepsis has been ranked as the 10th-leading cause of death in the U.S. "Time is of the essence, particularly when treating patients with sepsis," said Jonathan Grein, MD, associate director of Hospital Epidemiology and a Cedars-Sinai Medicine champion of the MEWS project along with Peachy Hain, RN, director of Medical-Surgical Rehabilitation. "Mortality increases significantly with every hour of delay, so it's important to begin treatment at the onset of infection."

In addition to improved mortality rates, other potential benefits of MEWS include decreased morbidity, reduced transfers to the ICU and earlier use of crisis nurses for assessment. While the number of RRTs is not expected to increase, it is expected that the timing of the RRT might result in earlier requests for evaluation in hopes of more rapid intervention and stabilization.

MEWS is intended for evaluation of adult patients only (18 or older) and will not be used in the Emergency Department, ICUs or Ob-Gyn, or for patients receiving comfort care.