A Prospective Study to Compare Clinical Acumen and Modified Early Warning Score (MEWS) in Post-Operative Surgical In -Patients at the University Teaching Hospital,Lusaka,Zambia

Abstract

Background: The safe recovery of patients admitted to hospital depends on early detection of clinical and physiological deterioration and undertaking appropriate intervention to prevent mortality. Modified early warning score (MEWS) is a structured objective way of monitoring patients’ condition using physiological parameters. It is an aggregation of vital signs, mental status assessment and urine output values taken by nurses during observations. Unlike the traditional charts, MEWS guides the nursing staff on when to call for medical staff to intervene. Therefore, eliminating the total reliance on nursing staffs’ clinical acumen to identify deteriorating patients and decide on when to call for help (Kyriacos2011).

The aim was to assess the effectiveness of modified early warning score (MEWS) as a tool for early identification of deteriorating post-operative surgical in-patients and facilitating early intervention. Specifically to determine the effect of using a cell phone on doctors’ rate to review patients. Methods: This prospective observational study was done at the University Teaching Hospital (UTH) in Lusaka over a period of two months involving all post-operative patients above the age of 18 years and excluding day cases. The patients were divided into three groups based on the tools for monitoring used in the ward; the first group used MEWS and a cell phone, the second group used MEWS alone and the third employed traditional charts. Nurses collected demographic data, clinical data, vital signs and MEWS. The qualitative data was analyzed using mean, percentage, Fisher exact test and two-sample t test with equal variances. Results: Of the 113 patients the median age was 40 (SD 16.9) years, 37 (33%) were females and 76 (67%) were males. 47 (42%) had elective while 66 (58%) had emergency surgery, 25 (22%) were in group with MEWS only, 41 (36%) MEWS & phone and 47 (42%) used traditional chart.

Doctors were called a total of 14 times to review patients who needed additional treatment. 7 times (50%) were in a group of MEWS and cell phone and 4 times (29%) in MEWS alone while the least number of times (3) was in the group that employed traditional charts. The difference was significant (P=0.034) using the Fisher exact test. The duration to review patients was shortest using the phone with mean difference of 33 minutes and P= 0.0062 at 95% using the two-sample t test with equal variances. Treatment outcomes were as follows 94 (83.19%) discharge while 18 (15.93%) died and 1 patient left against medical advice.