Improving Clinicians’ and Nurses’ Response to Abnormal Vital Signs in Hospital: The Roles of Modified Early Warning Scoring System and Rapid Response System

Abstract

Background: Most adverse events in hospitalised patients are often preceded by documented progressive deterioration of physiological parameters without appropriate responses. Modified Early Warning Score (MEWS) is a simple physiological score that was developed to aid early recognition of patient at risk of deterioration and assist in timely response especially in low and middle income countries where nurse patients ratio is low. Aim: To determine  nurses’ and clinicians’ responses to abnormal vital signs and to evaluate the usefulness of MEWS in early recognition of patients at risk of adverse outcome Methodology: This was a retrospective case-control study reviewed case notes of 264 patients discharged alive and 243 patients who died in Ladoke Akintola University of Technology Teaching Hospital Ogbomoso. The Patients’ relevant data and vital signs were gotten from case notes and were used to calculate Mean MEWS for each patient over 72 hours preceding outcome. Results: One hundred and fourteen (79.72%) of 143 patients with MEWS of above six were classified to be critically ill and managed in general wards instead of higher care unit. Mean MEWS among the patients discharged alive was statistically significantly lower than the dead patients (2.7±0.7 vs. 8.0±2.6, P<.001). Mean MEWS for pulse rate (0.2±0.63 vs. 2.1±1.0P<.001) and respiratory rate (1.2±0.01 vs. 2.3±0.75, P<.001) were statistical significantly lower for the patients discharged alive. The main reason for calling attention of clinicians to deteriorating patients was gasping in 52.6% of cases which is a late sign. Responses of house officers when called upon to review critically ill patients were to inform registrars in 44.03% of cases. There was a mean delay of 131(±66.28) minutes between house officers’ review and consultants’ inputs. Conclusion: Our study showed poor response to patients’ abnormal vital signs and significant delay in nurses’ and clinicians’ responses and decision making process; we thus suggest use of MEWS and introduction of rapid response system to aid early recognition and activation of clinicians with core competence in management of at risk patients.