Modified early warning system scoring and critical care readmission

Introduction

Modified early warning systems (MEWS) have been developed in an attempt to address suboptimal patient management prior to critical care admission [1]. The use of MEWS scoring as a predictor of critical care readmission has not been described previously.

Patients and methods

We have reviewed MEWS scores from all critical care discharges, from a 17-bed mixed medical/surgical critical care unit in a university teaching hospital, assessed by our outreach service from November 2004 to June 2005. Two hundred and thirty-eight patients were reviewed, with MEWS scoring being performed routinely at critical care discharge and at outreach review 24 hours later.

Results

Of the 238 patients reviewed, 197 underwent uneventful critical care discharge and did not require further admissions. Forty-one patients required readmission to critical care due to a deterioration of their presenting problem. The two groups of patients were well matched with respect to age, sex, medical/surgical split and admission Acute Physiology and Chronic Health Evaluation II score. The was no difference between the groups with respect to MEWS score at critical care discharge. MEWS score on outreach review, 24 hours after critical care discharge, was significantly higher in those patients requiring critical care readmission (Table 1).

Table 1

Conclusion

MEWS scoring at critical care discharge does not predict critical care readmission. MEWS scoring by the Critical Care Outreach Team 24 hours after discharge, however, appears to predict the need for critical care readmission.