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  • Early Warning and Decompensation

Early Warning and Decompensation

A service from the RADS2 team

Introduction to the Algorithm

MEWS is an algorithm that takes as its input serial vital signs, performs a computation, and predicts which patients will decompensate (deteriorate), thereby providing an actionable alert enabling collaboration among the rapid response team (RRT) and the bedside nurse.

The MEWS application provides for:

  • Another layer of surveillance
  • Additional eyes on a potentially ill patient
  • Skill Development for the bedside nurse
  • Prevention of unplanned admissions to ICU and death

Application Roadmap

The RADS2 team has implemented the generation of MEWS score in real-time with the following features: 

  • MEWS application returns the Heart Rate, SaO2, Respiratory Rate, Hypotension, Urine output, Temperature values to determine the MEWS score 
  • If the total score >4 then it sends the list of the patients at risk of clinical decompensation to the nurses
  • MEWS scores are cached every 10mins to provide the most recent Real Time Data

A pilot study is ongoing on 4 units where the rapid response team interacts with the patient and bedside nurse when a threshold score is triggered in order to assist in providing early interventions with the goal of preventing further decompensation.

The EWS envisioned by the RADS2 would further personalize the system (Personalized EWS or PEWS), enabling it to fire in response to each patient’s unique pathophysiology, taking into consideration individual patient’s “Set Points”. 

As part of the envisioned EWS, following are the additional features that are being considered for the MEWS application:

  • Alerting mechanisms triggered upon deterioration of patient condition
  • Information as to what triggered the alert
  • Inclusion of device, conventional EMR and derived data to personalize the MEWS
  • Post discharge monitoring of the patient
  • Making the MEWS algorithm scores available to the bedside nurses and providers without having to login to external systems

Design and Implementation

The Cerner EMR database is the source for clinical events relating to heartrate, hypotension, respioratory rate, temperature and oxygen saturation for a patient. We have created database views that capture these events and stored procedures that calculate the MEWS score from the data in these views. This information is pulled into the RTA production database every 10 minutes.

 

MEWS Design and Implementation


Scoring System Details

The following table shows the system followed generated scores for the application:

System followed generated scores
Emory Real-time Analytics, Data Science and Decision Support (RADS2)
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    • Sepsis Prediction
    • Unplanned ED Admission (UEDA)
    • eARDS
  • Clinical Operations
    • COVID-19 Patient Care Dashboard
    • Health Equity Data Sandbox
    • Mechanical Ventilation
    • CRRT
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Stakeholders

Dr. Jessica Nave, MD
Assistant Professor of Medicine

Dr. Jessica Nave attended the University of Oklahoma for her medical degree and completed her Internal Medicine residency training at Emory. She serves as the Associate Site Director of Hospital Medicine at Emory University Hospital, Co-chair of EUH Resuscitation Committee, Co-chair of the system level EHC Medical Emergency Response Oversight Committee, and the Medical Director of the Rapid Response Team at EUH.

Dr. Jessica Nave

Martha Boudreau DNP, MN, FNP-BC, CCRN,
Education Coordinator/Cardiac ICU & Rapid Response Team

Martha Boudreau attended Mount Saint Mary College for her Bachelor of Science in Nursing degree and Emory University for her Masters degree and Family Nurse Practitioner Certificate. She recently graduated with her Doctorate of Nursing Practice at Regis College in Massachusetts and is a Board Certified Family Nurse Practitioner and Critical Care Registered Nurse. She serves as the Education Coordinator for the Cardiac Intensive Care Unit and Rapid Response team at Emory University Hospital and serves as Co-chair of the EUH Resuscitation Committee at EUH.

Martha Boudreau
Emory University Homepage

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