Understanding Differences in Medical Versus Surgical Patients Alerted by the Modified Early Warning Score (MEWS) at Jefferson Hospital
An Early Warning Score (EWS) is a risk-management tool to identify patients experiencing clinical deterioration early, therefore allowing timely treatment to occur. Although EWS scores are recommended for all in-patients, more data is available for patients under general medical services compared to surgical services. This study aims to understand differences between medical versus surgical in-patients who receive a red alert from the Modified Early Warning Score (MEWS) at Jefferson hospital. Patients who received a red MEWS alert during admission and discharged between June 2017 to March 2018 (N=812) were categorized as medical or surgical patients. Patient characteristics were compared using an independent samples t-test (age, alert count) or chi-square test (sex, race, admission source, insurance). Patient outcomes were compared using a binary logistic regression (in-hospital mortality, RRT, sepsis diagnosis, ICU transfer, intubation, discharge to hospice) or a Cox regression model (length of stay), controlling for age, sex, and race. Compared to medical patients, surgical patients were younger by 2.7 years (p=0.026) and more likely to have a Commercial and/or Medicare category of insurance (OR=1.568, p=0.005). Surgical patients were more likely to have ICU transfer (OR=1.487, p=0.013) and intubation post-alert (OR=2.470, p=0.006), while less likely to be discharged early (HR=0.675, p<0.001). Of all patients who survived to discharge, surgical patients had lower odds of being discharged to hospice (OR=0.452, p=0.006). Similarities in the populations justify MEWS implementation for all in-patients, while subtle differences are valuable to the medical community at large and can inform local modifications to the EWS and associated clinical processes currently in place.
Recommended CitationPatel, MD, MPHc, Nisha M.; Jaffe, MD, Rebecca C.; and George, PhD, MS, Brandon, "Understanding Differences in Medical Versus Surgical Patients Alerted by the Modified Early Warning Score (MEWS) at Jefferson Hospital" (2018). Master of Public Health Thesis and Capstone Presentations. Presentation 256.