Evaluating modified early warning score compliance to minimise unnecessary ICU admissions: a needs assessment for quality improvement implementation
Introduction: Intensive care unit (ICU) resources remain limited in low- and middle-income countries (LMICs), with Pakistan having a median of 0.7 ICU beds per 100,000 population.1,2 The modified early warning score (MEWS) facilitates timely identification of patient deterioration, enabling interven...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
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| Series: | Clinical Medicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1470211825001137 |
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| Summary: | Introduction: Intensive care unit (ICU) resources remain limited in low- and middle-income countries (LMICs), with Pakistan having a median of 0.7 ICU beds per 100,000 population.1,2 The modified early warning score (MEWS) facilitates timely identification of patient deterioration, enabling interventions that prevent unnecessary ICU admissions and adverse outcomes. Yet, real-world triaging often deviates from MEWS-based recommendations. Research question: Does adherence to MEWS-based ICU admission criteria improve patient outcomes, and what factors contribute to deviations from standardised triaging protocols? Materials and Methods: A descriptive cross-sectional analysis was conducted on 120 ICU admissions over 3 months (July–October 2024). Data were extracted from ICU logs, medical records and hospital admission databases. Analyses included descriptive statistics, Chi-square tests for associations between MEWS adherence and outcomes, logistic regression to quantify predictive relationships, and correlation analyses for MEWS scores and ICU length of stay. Results and Discussion: Only 34.2% of ICU admissions met MEWS criteria, while 65.8% were admitted despite not meeting the threshold.1 Polytrauma and neurosurgery accounted for 40% of admissions, with high non-compliance rates (62.5% and 75%, respectively). Patients meeting MEWS criteria had a 75.3% lower likelihood of mortality (OR=0.247; 95% CI: 0.111–0.548) (Fig 1). MEWS showed a weak correlation with ICU stay duration (Pearson: 0.05, p=0.5759). Interestingly, age stratified analysis showed that middle-aged adults (40–59 years) had the longest ICU stays (7.4 days), followed by young and older adults.Our study indicated that, despite being a valuable screening tool, integrating clinical judgment with MEWS is necessary to optimise ICU triaging in diverse healthcare settings. A statistically significant association between MEWS adherence and patient outcomes in our study underscores the importance of early identification of deteriorating patients in improving outcomes and reducing readmissions.3 The variability in ICU stay lengths across different MEWS scores in our study highlights the complexity of patient management in critical care. The wider interquartile ranges for MEWS scores 3 and 6 suggest that, while some patients require prolonged ICU care, others do not, indicating the necessity of a more nuanced approach beyond scoring systems. Conclusion: Despite MEWS being a strong mortality predictor, ICU triaging in this setting relied heavily on physician judgment, leading to frequent deviations from standardised criteria. To address this, quality improvement strategies, such as standardised protocols, physician training, digital decision-support tools, routine audits and expanded high-dependency units, are recommended (Fig 2). These measures can optimise ICU resource allocation and reduce unnecessary admissions, ensuring a structured, yet flexible triaging approach that balances protocol adherence with clinical discretion. |
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| ISSN: | 1470-2118 |