Marjon Borgert

25 Standardized measurement of the Modified Early Warning Score INTRODUCTION Rapid Response Systems (RRS) have been implemented without unequivocal evidence regarding their e ectiveness. 1,2 The goal of RRS is to identify clinical deteriorating patients in hospitals to prevent cardiopulmonary arrests, unplanned admissions to the Intensive Care Unit (ICU) and unexpected deaths. 3 Up to 80% of patients have vital signs abnormalities in the 24 hours prior to adverse events (AE). 4-6 Presence of suboptimal care and lack of clinical urgency are suggested as signi cant contributors. 7,8 To aid in the detection process of patients at risk for AE, Track and Trigger Systems have been developed. 9 One commonly used is the Modi ed EarlyWarning Score (MEWS), whereby nurses allocate points to themeasurement of vital signs resulting in a summary score. 10,11 Upon reaching a prede ned threshold, either the primary physician and/or a Rapid Response Team (RRT) is activated. In general the RRT consists of an ICU physician and nurse who respond within 10 minutes after activation. 12,13 This system combined with educational and organizational components is called a RRS. 14 The MERIT trial measured the e ect of a RRS but was unable to show a signi cant clinical bene t. 15 Post hoc analyses identi ed a high rate of a erent limb failure, i.e. failure to respond to patients with signs of deterioration. 16 Although the face-validity of RRS is high, universal spread and acceptance of the system is hampered by the lack of robust evidence. 17 Current research is focused on a erent limb failure and causes for the delay in identifying deteriorating patients in hospitals where these systems are already implemented. 8,18 It is clear thatmonitoringof patients ongeneral wards is not uniform innature andunreliable even in hours prior to AE. 19 Even after major surgery, measurements of vital signs might be incomplete or absent, 20 while evidence is present that increased monitoring is associated with improved outcome. 21,22 In the Netherlands the implementation of a RRS has recently been dictated by the Health Care Inspectorate. We studied the e ect of a protocolized measurement (three times daily) of the MEWS versus measurement on indication on the degree of implementation of the RRS.