Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support.

Lorena Micheline Alves Silva,José Paulo Pintya,Diego Marques Moroço,Carlos Henrique Miranda,Steve Lin

doi:10.1371/journal.pone.0259577

Lorena Micheline Alves Silva, José Paulo Pintya + Show 3 more

Open Access

https://doi.org/10.1371/journal.pone.0259577

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Journal: PloS one	Publication Date: Nov 11, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Universidade de São Paulo

Abstract

BackgroundEmergency department (ED) crowding is a frequent situation. To decrease this overload, patients without a life-threating condition are transferred to wards that offer ED support. This study aimed to evaluate if implementing a rapid response team (RRT) triggered by the modified early warning score (MEWS) in high-risk wards offering ED support is associated with decreased in-hospital mortality rate.MethodsA before-and-after cross-sectional study compared in-hospital mortality rates before and after implementation of an RRT triggered by the MEWS ≥4 in two wards of a tertiary hospital that offer ED support.ResultsWe included 6863 patients hospitalized in these wards before RRT implementation from July 2015 through June 2017 and 6944 patients hospitalized in these same wards after RRT implementation from July 2018 through June 2020. We observed a statistically significant decrease in the in-hospital mortality rate after intervention, 449 deaths/6944 hospitalizations [6.47% (95% confidence interval (CI) 5.91%– 7.07%)] compared to 534 deaths/6863 hospitalizations [7.78% (95% CI 7.17–8.44)] before intervention; with an absolute risk reduction of -1.31% (95% CI -2.20 –-0.50).ConclusionRRT trigged by the MEWS≥4 in high-risk wards that offer ED support was found to be associated with a decreased in-hospital mortality rate. A further cluster-randomized trial should evaluate the impact of this intervention in this setting.

Highlights

Emergency department (ED) crowding is a significant problem in many localities worldwide [1]
We included 6863 patients hospitalized in these wards before rapid response team (RRT) implementation from July 2015 through June 2017 and 6944 patients hospitalized in these same wards after RRT implementation from July 2018 through June 2020
We observed a statistically significant decrease in the in-hospital mortality rate after intervention, 449 deaths/6944 hospitalizations [6.47% (95% confidence interval (CI) 5.91%– 7.07%)] compared to 534 deaths/6863 hospitalizations [7.78%] before intervention; with an absolute risk reduction of -1.31%

Summary

Introduction

Patients without a life-threatening condition are transferred to wards that offer ED support to decrease this overload [2] These patients have a high risk of clinical deterioration, and often a limited number of electronic devices are available to monitor all these patients. Higher MEWS scores indicate worsening clinical status This score is usually applied to activate a rapid-response team (RRT), which is a healthcare team dedicated to early identification of and response to clinical deterioration in hospital-ward patients to avoid intensive care unit (ICU) admission or cardiac arrest. Emergency department (ED) crowding is a frequent situation To decrease this overload, patients without a life-threating condition are transferred to wards that offer ED support. This study aimed to evaluate if implementing a rapid response team (RRT) triggered by the modified early warning score (MEWS) in high-risk wards offering ED support is associated with decreased in-hospital mortality rate

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