Modified early warning scoring (MEWS): evaluating the evidence for tool inclusion of sepsis screening criteria and impact on mortality and failure to rescue

Aims and objectives: To evaluate current research evidence reporting outcomes from modified early warning scoring system tools utilisation to prevent failure to rescue in hospitalised adult medical-surgical/telemetry patients.

Background: Early sepsis detection exhibits clinical significance to practitioners and patients. Thorough and timely clinical observations, along with a willingness of nurses to call for help, are pivotal to survival of hospitalised patients. This project examined effects of modified early warning scoring system tool usage on patient mortality and failure to rescue events in hospitalised adult medical-surgical/telemetry patients as reported in the literature.

Design: A comprehensive review and evaluation of published peer-reviewed literature was conducted.

Methods: Electronic databases searched included PubMed, MEDLINE, CINAHL, Cochrane Library of systematic reviews and Agency for Healthcare Research and Quality through 2014.

Results: Eighteen articles were identified for review. Evidence ratings included 6% (1) Level I, 44% (8) Level IV, 6% (1) Level V, 33% (6) Level VI and 11% (2) Level VII. Six reported mortality predictive value and/or reduction, three measured impact on emergency calls, and four reported impact on mortality and rapid response team utilisation.

Conclusion: While modified early warning scoring system tools have been widely adopted and are recommended for utility in detection of inpatients at-risk for clinical deterioration, limited high-level data and no clinical trials linking use of modified early warning scoring system tool usage to robust outcomes were found. Established criteria for validating modified early warning scoring system criteria, organisational-specific reliability testing and multi-site trials are recommended.

Relevance to clinical practice: Development of all-cause illness screening tools, including sepsis, is imperative. The clinical picture may be quantified with scoring tools to assist nurses' clinical decision-making, thus leading to improved outcomes and decreased incidence of failure to rescue. Clinical outcomes of interest should be measured and reported in peer-reviewed literature to disseminate the impact on clinical outcomes.