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Evaluating the Impact of Introducing Modified Early Warning Score to Identify Deteriorating Patients in the Wards at a Tertiary University Hospital - A before-after Study

BACKGROUND 
Modified early warning score (MEWS) is a scoring system being used in hospitals for the identification of patients who may deteriorate into medical emergencies or cardiac arrest. However, the mortality benefit of MEWS hasn’t been established. Also, there is limited data about the experience of MEWS being implemented in low-income countries. Hence, we conducted a before-after prospective observational study to evaluate the impact on ICU mortality post-introduction of the MEWS chart. 
METHODS 
MEWS before-after study is a single-centre prospective observational study in a tertiary university hospital conducted in the ICU at Kasturba Hospital, Manipal University, India. We trained ward nurses on MEWS and introduced the MEWS chart and compared the change in outcomes from two months prior (i.e. February-March 2018) to the subsequent two months (i.e. April-May 2018). The primary outcome measured was the ICU mortality between the samples. Our secondary outcomes were the length of stay (LOS) and hospital mortality. Student t-test was used to estimate the total sample size and we used the chi-square test for statistical analyses. 
RESULTS 
We enrolled 161 patients into each group and the patient demographics between groups did not show any statistically significant difference. The ICU mortality data did not show any statistically significant difference before the introduction of MEWS after using the chi-square test with a p-value of 0.33. There was no statistically significant difference in ICU LOS, ICU re-admission rates, hospital LOS, hospital mortality, bed occupancy rates, or incidence of CPR between the two periods. 
CONCLUSIONS 
Our study did not show a significant difference in the mortality after introduction of MEWS scoring charts to our wards. The introduction of critical care outreach services may improve the outcomes.