PMID- 29771722
OWN - NLM
STAT- MEDLINE
DCOM- 20200507
LR  - 20210203
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 271
IP  - 1
DP  - 2020 Jan
TI  - Detection of Deteriorating Patients on Surgical Wards Outside the ICU by an 
      Automated MEWS-Based Early Warning System With Paging Functionality.
PG  - 100-105
LID - 10.1097/SLA.0000000000002830 [doi]
AB  - BACKGROUND: The establishment of early warning systems in hospitals was strongly 
      recommended in recent guidelines to detect deteriorating patients early and 
      direct them to adequate care. Upon reaching predefined trigger criteria, Medical 
      Emergency Teams (MET) should be notified and directed to these patients. The 
      present study analyses the effect of introducing an automated multiparameter 
      early warning score (MEWS)-based early warning system with paging functionality 
      on 2 wards hosting patients recovering from highly complex surgical 
      interventions. METHODS: The deployment of the system was accompanied by 
      retrospective data acquisition during 12 months (intervention) using 4 routine 
      databases: Hospital patient data management, anesthesia database, local data of 
      the German Resuscitation Registry, and measurement logs of the deployed system 
      (intervention period only). A retrospective 12-month data review using the same 
      aforementioned databases before the deployment of the system served as control. 
      Control and intervention phases were separated by a 6-month washout period for 
      the installation of the system and for training. RESULTS: Data from 3827 patients 
      could be acquired from 2 surgical wards during the two 12-month periods, 1896 
      patients in the control and 1931 in the intervention cohorts. Patient 
      characteristics differed between the 2 observation phases. American Society of 
      Anesthesiologists risk classification and duration of surgery as well as German 
      DRG case-weight were significantly higher in the intervention period. However, 
      the rate of cardiac arrests significantly dropped from 5.3 to 2.1 per 1000 
      admissions in the intervention period (P < 0.001). This observation was 
      paralleled by a reduction of unplanned ICU admissions from 3.6% to 3.0% (P < 
      0.001), and an increase of notifications of critical conditions to the ward 
      surgeon. The primary triggers for MET activation were abnormal ECG alerts, 
      specifically asystole (n = 5), and pulseless electric activity (n = 8). 
      CONCLUSION: In concert with a well-trained and organized MET, the early 
      deterioration detection of patients on surgical wards outside the ICU may be 
      improved by introducing an automated MEWS-based early warning system with paging 
      functionality.
FAU - Heller, Axel R
AU  - Heller AR
AD  - Department of Anesthesiology and Intensive Care, Medizinische Fakultat an der 
      TU-Dresden, Germany.
FAU - Mees, Soren T
AU  - Mees ST
AD  - Department of Visceral, Thoracic, and Vascular Surgery, Medizinische Fakultat an 
      der TU-Dresden, Germany.
FAU - Lauterwald, Benjamin
AU  - Lauterwald B
AD  - Department of Anesthesiology and Intensive Care, Medizinische Fakultat an der 
      TU-Dresden, Germany.
FAU - Reeps, Christian
AU  - Reeps C
AD  - Department of Visceral, Thoracic, and Vascular Surgery, Medizinische Fakultat an 
      der TU-Dresden, Germany.
FAU - Koch, Thea
AU  - Koch T
AD  - Department of Anesthesiology and Intensive Care, Medizinische Fakultat an der 
      TU-Dresden, Germany.
FAU - Weitz, Jurgen
AU  - Weitz J
AD  - Department of Visceral, Thoracic, and Vascular Surgery, Medizinische Fakultat an 
      der TU-Dresden, Germany.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
MH  - Aged
MH  - *Early Diagnosis
MH  - Female
MH  - Follow-Up Studies
MH  - Germany/epidemiology
MH  - Heart Arrest/*diagnosis/epidemiology/prevention & control
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Intensive Care Units/*statistics & numerical data
MH  - Male
MH  - Medical Records/*standards
MH  - Middle Aged
MH  - Patients' Rooms/*organization & administration
MH  - Retrospective Studies
MH  - Risk Assessment/*methods
EDAT- 2018/05/18 06:00
MHDA- 2020/05/08 06:00
CRDT- 2018/05/18 06:00
PHST- 2018/05/18 06:00 [pubmed]
PHST- 2020/05/08 06:00 [medline]
PHST- 2018/05/18 06:00 [entrez]
AID - 00000658-202001000-00016 [pii]
AID - 10.1097/SLA.0000000000002830 [doi]
PST - ppublish
SO  - Ann Surg. 2020 Jan;271(1):100-105. doi: 10.1097/SLA.0000000000002830.