Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support
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 (M...
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| description | 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.
A 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.
We 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).
RRT 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. |
| doi_str_mv | 10.1371/journal.pone.0259577 |
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A 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.
We 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).
RRT 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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0259577</identifier><identifier>PMID: 34762677</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Aged ; Biology and Life Sciences ; Cardiac arrest ; Clinical Protocols ; Confidence intervals ; Consciousness ; Cross-Sectional Studies ; Early Warning Score ; Electronic health records ; Emergency medical care ; Emergency medical services ; Emergency service ; Emergency Service, Hospital - statistics & numerical data ; Fatalities ; Female ; Health risks ; Hospital Mortality ; Hospital Rapid Response Team - statistics & numerical data ; Hospitalization ; Hospitals ; Humans ; Internal medicine ; Male ; Medical care ; Medical records ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Monitoring systems ; Mortality ; Patients ; People and Places ; Physicians ; Quality management ; Risk management ; Risk reduction ; Statistical analysis ; Tertiary ; Tertiary Care Centers ; Vital signs</subject><ispartof>PloS one, 2021-11, Vol.16 (11), p.e0259577</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 Alves Silva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 Alves Silva et al 2021 Alves Silva et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-dfb4368f5c5089c9207b6e28f29d5c9f38b5c375df05d5c48c3442cf14565abb3</citedby><cites>FETCH-LOGICAL-c692t-dfb4368f5c5089c9207b6e28f29d5c9f38b5c375df05d5c48c3442cf14565abb3</cites><orcidid>0000-0002-5968-4879</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584721/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584721/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,725,778,782,862,883,2098,2917,23849,27907,27908,53774,53776,79351,79352</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34762677$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Lin, Steve</contributor><creatorcontrib>Alves Silva, Lorena Micheline</creatorcontrib><creatorcontrib>Moroço, Diego Marques</creatorcontrib><creatorcontrib>Pintya, José Paulo</creatorcontrib><creatorcontrib>Miranda, Carlos Henrique</creatorcontrib><title>Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
A 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.
We 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).
RRT 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Biology and Life Sciences</subject><subject>Cardiac arrest</subject><subject>Clinical Protocols</subject><subject>Confidence intervals</subject><subject>Consciousness</subject><subject>Cross-Sectional Studies</subject><subject>Early Warning Score</subject><subject>Electronic health records</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Emergency service</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Fatalities</subject><subject>Female</subject><subject>Health risks</subject><subject>Hospital Mortality</subject><subject>Hospital Rapid Response Team - statistics & numerical data</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Internal 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Paulo</au><au>Miranda, Carlos Henrique</au><au>Lin, Steve</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-11-11</date><risdate>2021</risdate><volume>16</volume><issue>11</issue><spage>e0259577</spage><pages>e0259577-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
A 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.
We 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).
RRT 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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>34762677</pmid><doi>10.1371/journal.pone.0259577</doi><tpages>e0259577</tpages><orcidid>https://orcid.org/0000-0002-5968-4879</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Biology and Life Sciences Cardiac arrest Clinical Protocols Confidence intervals Consciousness Cross-Sectional Studies Early Warning Score Electronic health records Emergency medical care Emergency medical services Emergency service Emergency Service, Hospital - statistics & numerical data Fatalities Female Health risks Hospital Mortality Hospital Rapid Response Team - statistics & numerical data Hospitalization Hospitals Humans Internal medicine Male Medical care Medical records Medicine Medicine and Health Sciences Middle Aged Monitoring systems Mortality Patients People and Places Physicians Quality management Risk management Risk reduction Statistical analysis Tertiary Tertiary Care Centers Vital signs |
| title | Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support |
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