1045 Characteristics and outcomes of women with MEWS (Maternal Early Warning Signs) in a community hospital

Abstract

MEWS are a routine feature of many obstetrical safety programs. However, there are limited published data on their impact. Our objectives were to assess the frequency, severity, and outcomes of women with MEWS trigger events at a community hospital. We performed a retrospective cohort study of all MEWS trigger events for pregnant and post partum women occurring at a community Level 2 hospital from 10/1/2019-8/31/2020. MEWS criteria followed definitions proposed by the California Collaborative: systolic blood pressure less than 90 or greater than 160 mmHg, heart rate less than 50 or greater than 120 beats per minute, respiratory less than 10 or greater than 30 breaths per minute, oxygen saturation less than 95%, and urine output less than 35 milliliters per hour for 2 hours. Maternal and newborn hospital charts were reviewed for clinical details. Timing of MEWS (antepartum, intrapartum, postpartum), primarily etiology (hypertension, infection, hemorrhage), severity, and outcomes were analyzed. Out 1,582 deliveries, 41 patients (2.6%) had MEWS. Out of these, 24 (59%) had multiple triggers; 74% of MEWS occurred in the postpartum period and 69% occurred in patients who underwent a cesarean delivery. Hypertension accounted for 87% of MEWS and 81% of all MEWS resulted in intervention, whether it was medication administration (75%), Intensive Care Unit admission (1%), consultation by a specialty service (9%), or maternal transfer to a higher level of care (2%). After a MEWS event, no patients required a rapid response team (RRT) call. In a community Level 2 hospital, MEWS triggers occurred in 2.6% of hospitalizations; most had postpartum timing, were in women following cesarean delivery, were related to HTN, and almost always resulted in change in maternal care.