Impact of a systematic MEWS introduction on preoperative and postoperative evaluation in urgent/emergency surgery

Introduction

The Modified Early Warning Score (MEWS) has been used in medical wards as a decision-making instrument. Here we show a pilot study on MEWS introduction as a routine method for care improvement in urgency/emergency surgical patients.

Methods

Patients enrolled underwent urgent/emergency surgery due to trauma, appendicitis, cholecystitis, gut perforation or ischemia. Data collection with MEWS involved patients admitted for between April and October 2009. It was measured during preoperative evaluation and within 24 hours after surgery. To evaluate the role of MEWS utilization we use as outcome criteria: hospital length of stay (LOS), mortality, ICU or subintensive care unit (SCU) need. The MEWS group was compared with a control historical group (January 2008 to March 2009).

Results

Groups were similar in surgical diagnosis and demographic characteristics. Patients of the control group showed a higher mortality rate compared with the MEWS group (6.7 vs 3.7). The number of SCU admissions after surgery passed from 9.6% to 15.4% after MEWS introduction, whereas need for an ICU bed decreased from 12.9% to 10.6% (Table 1). Linear regression between high MEWS score and hospital LOS resulted significant (P < 0.001).

Table 1

Conclusions

These preliminary results indicate that MEWS, used in preoperative evaluation and follow-up in urgent/emergency surgical patients, can have an important impact on patient care and mortality.