M.E.W.S. / Sepsis / PESI

Modified early warning score M.E.W.S. The personnel in the wards must be able to monitor admitted patients with adequate instruments: the MEWS (Modified Early Warning Score) model is a data collection and scoring system for monitoring a patient’s condition and increases the attention to the patient, and when necessary, allows for timely activation of the MET (Medical Emergency Team).

It provides:

  • analysis of vital signs provided by the monitoring
  • assigns a score for each value measured in accordance with MEWS
  • calculates the Total MEWS Score:
    • if < 5: standard assistance protocol is applied
    • if >=6: the Service Centre in Intensive Care is alerted and the Medical Emergency Team (MET) is activated.

The use of aggregated scoring such as the MEWS, Modified Early Warning Score, provides an assessment of the systolic blood pressure, heart rate, respiratory rate, body temperature and level of consciousness using AVPU (Alert, Verbal, Pain, Unresponsive) allows for the early identification of deteriorating vital signs. The response team is activated by the "Track&Trigger" system, depending on the MEWS score obtained.

Results obtained from the literature:

  • Reduction of the “cardiac arrest” event in non-ICU areas by 50%. Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324:387-390.
  • Reduction in admission of critical post-operative patients into ICU (58%) and deaths (37%). Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates. Crit Care Med. 2004;32:916-921.
  • Reduction of cardiac arrest prior to transfer into ICU (4% vs. 30%). Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A. The patient-at-risk team: identifying and managing seriously ill ward patients. Anesthesia. 1999;54(9):853-860.
  • 17% Reduction in cardiac arrest incidents (6,5 vs. 5,4 per 1000 admissions). De Vita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL. Use of medical emergency team responses to reduce hospital cardiopulmonary arrests. Qual Saf Health Care. 2004;13(4):251-254.

Sepsis/Severe Sepsis screening tool

Sepsis/Severe Sepsis screening tool: it allows for the early detection of the various stages of SEPSIS (SUSPECTED SEPSIS; DOCUMENTED SEPSIS; SEVERE SEPSIS; SEPSIS SHOCK) thanks to the interpolation of data from:

  • the patients clinical condition;
  • physiological parameters;
  • blood chemistry analysis.

Pulmonary Embolism Severity Index (PESI)

The Pulmonary Embolism Severity Index (PESI) is a clinical prediction rule used to assess risk of adverse outcomes in patients presenting with pulmonary embolism. This score is calculated on the basis of the clinical information and physiological parameters of the patient. Based on this score, the patient is assigned a degree of risk:

  • Grade I; Very low risk: 0-1.6% 30-day mortality
  • Grade II; Low risk: 1.7-3.5% 30-day mortality
  • Grade III; Intermediate Risk: 3.2-7.1% 30-day mortality
  • Grade IV; High Risk: 4.0-11.4% 30-day mortality
  • Grade V; Very high risk: 10.0-24.5% 30-day mortality