Introduction The Modified Early Warning Score (MEWS) was developed and validated as an objective scoring system to aid healthcare staff in identifying patients at risk of “catastrophic deterioration” in the acute hospital setting(1). At the Royal Liverpool and Broadgreen University Hospitals NHS Trust (RLBUHT), the Acute Response Team (ART) is led by advanced nurse practitioners, who respond to calls when patients have a MEWS of 4 or more. It was noted that a large proportion of calls were to respiratory patients, many requiring no intervention.
Methods Details of every ART call to medical patients throughout 2012 (n = 883) were recorded on clinical proforma and collated on an Excel database. Data were analysed using STATA 12, as part of a service evaluation. Outcomes measured were: numbers of ART calls made to respiratory and remaining medical wards, numbers of Do Not Attempt Resuscitation (DNAR) orders in place, MEWS, investigations performed by the ART, critical care transfer and the 7 and 30 day mortality.
Results The 53 respiratory beds account for only 14% of the medical bed-base but generated 25% of ART calls. Respiratory patients scored more highly on respiratory rate (RR) and oxygen saturations (SpO2) MEWS parameters than other medical patients. ART investigation rates were similar in all patients but only 1% were transferred from respiratory to critical care. There were more DNAR orders and both 7 and 30 day mortality were higher on the respiratory wards (see Table 1).
Discussion Many respiratory patients score highly on RR and SpO2 MEWS parameters due to their chronic disease. The increased use of DNAR orders in respiratory patients reflects a greater burden of chronic disease and therefore a poorer prognosis. This may explain the low rates of transfer to critical care and high mortality rates. We suggest a respiratory-specific MEWS may reduce ART calls to stable respiratory patients and, for respiratory patients with DNAR orders, automatic exemption from ART calls should be considered.
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