Identification of deteriorating patients on general wards; measurement of vital parameters and potential effectiveness of the Modified Early Warning Score

Background and Purpose: Clear and detectable signs of deterioration have been shown to be present in many patients multiple hours before undergoing a serious life-threatening event. To date, few studies are available describing normal practice and the possible effectiveness of structured tools regarding recognition of deteriorating patients. The aim of this study was to describe the current practice in measurement and documentation of vital signs and the possible usefulness of the Modified Early Warning Score (MEWS) to identify deteriorating patients on hospital wards. Methods: A retrospective observational study of medical and surgical patients from 2007 with a severe adverse event including cardiopulmonary arrest, unplanned intensive care unit admission, emergency surgery, or unexpected death was performed. We studied all vital parameters that were collected and documented in the 48 hours before these events, and the MEWS was retrospectively calculated. Results: Two hundred four patients were included. In the 48 hours before the event, a total of 2688 measurements of one or more vital signs were taken. Overall, 81% of the patients had an MEWS value of 3 or more at least once during the 48 hours before their event. Recordings of vital signs were mostly incomplete. Even when the MEWS was 3 or more, respiratory rate, diuresis, and oxygen saturation were documented in only 30% to 66% of assessments. (C) 2012 Elsevier Inc. All rights reserved.