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Thursday, May 30, 2013

Bradford, Olean Hospitals Implement
Electronic Modified Early Warning System

Bradford Regional Medical Center (BRMC) and Olean General Hospital (OGH), members of the Upper Allegheny Health System, have successfully incorporated the Modified Early Warning System (MEWS) into their existing Electronic Health Records system.

MEWS is a scoring system that provides early warning and recognition to nurses and physicians about patients who are deteriorating physically so that appropriate medical interventions can be taken to help prevent cardiac arrests and other sudden life threatening events. The MEWS system signals nurses and physicians to potential patient problems based on the assignment of an aggregate score based upon a patient’s vital signs. Decision support capability embedded within the two hospitals’ electronic health record systems automatically calculates a MEWS score and signals any need for medical interventions. At OGH and BRMC, a MEWS score is calculated for patients based upon multiple vital signs that include: systolic blood pressure, heart rate, respiratory rate, temperature, and level of consciousness.

Typically, in most hospitals, patient interventions are triggered based on a single vital sign. For example, a significant change in a patient’s blood pressure will often trigger a particular response from nursing staff. While a single parameter approach has been effective, MEWS responds to multiple vital signs of a patient at the same time and identifies at risk patients at the first sign of a subtle change in them.

“Upper Allegheny Health System is very excited to be implementing MEWS as part of our hospitals’ electronic health record. This is groundbreaking work that represents a very significant enhancement to patient safety and the quality of care offered within our facilities,” said Timothy J. Finan, President and CEO.

MEWS works by assigning each vital sign a score between 0 and 3 depending upon what it is. The sum of the values of the different vital signs yields a patient’s total MEWS score. Depending on this score, specific medical interventions are prescribed for nursing and physicians. Again, the electronic record’s clinical decision support capability automatically provides the scoring and signals the appropriate intervention. Specific interventions triggered by this system, depending upon the MEWS score, might include increased monitoring of a patient’s vital signs, notification of the patient’s physician, activation of the hospitals’ emergency response team, or patient transfer to the Intensive Care Unit. Hospitals that have implemented MEWS have experienced very significant reductions in in-hospital cardiac arrests and patient transfers to the ICU.

The idea of instituting MEWS at OGH and BRMC was the result of an internal study process at the Upper Allegheny Health System to identify opportunities to leverage the two hospitals’ electronic health record to improve patient quality and safety. A multidisciplinary team visited Geisinger Health System, an integrated health system widely recognized for its innovative use of the electronic health record, and was impressed with their implementation and use of the MEWS system.

“This is going to save lives,” said William Mills, MD, Senior Vice President, Quality and Professional Affairs for UAHS. “MEWS at Olean General Hospital and Bradford Regional Medical Center leverages the power of the electronic record and much like a warning light for the pilot in an airplane’s cockpit, helps to spot problems early so that they can be addressed immediately.”

“One of the many benefits of electronic record systems is real-time clinical decision support,” said Jeff Zewe, Chief Nursing Officer and Vice President of Patient Services. “Computers automatically calculate the MEWS score and alert nursing staff of a potential change in a patient’s condition,” he added. Each MEWS score will trigger specific actions. The goal of these interventions is the aversion of any further decline in a patient’s health status.

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