Volume 195 - Issue 8
Use of the modified early warning score in emergency medical units
Authors: Imogen A Mitchell, Mary-Ann Kulh and Heather McKay
Med J Aust 2011; 195 (8): 448. || doi: 10.5694/mja11.10995
Published online: 17 October 2011
Published online: 17 October 2011
To the Editor: Since 2008, the Australian Capital Territory’s public acute health care system has successfully been using multiple-parameter and single-parameter track, trigger and response (TTR) systems in parallel for the recognition of and response to clinical deterioration in patients. Jenkins and colleagues correctly identify that there is a general lack of agreement on the use of TTR systems around Australia, although they note that the most commonly used rapid response system is the medical emergency team (MET) alert which is triggered by a single parameter, a vital sign derangement, or a concern for the patient.1 As Jenkins et al suggest, a multiple-parameter TTR system may trigger a response earlier than might occur with MET parameters.
In 2007 at Canberra Hospital, a multifaceted before-and-after intervention study of the recognition of and response to patients’ deteriorating conditions found improvements in both patient outcomes and measures of processes of care for patients whose condition was deteriorating.2 The intervention included the installation of a multiple-parameter TTR system, using a modified early warning score3 generated from the degree of derangement of all vital signs and end organ function. Individual vital sign early warning scores were then colour-coded and embedded within newly formatted, human-factors-designed observation charts. Further, before the new system commenced, about 90% of all health care workers (210/234) participated in an education program.4 This program comprised both an e-learning package and a 3-hour, face-to-face, low-fidelity simulation package. It aimed to promote the understanding of the physiological principles of vital signs, and reasons for their measurement and their derangement; it also provided a structure for succinct communication and initial resuscitation.
The multiple-parameter TTR system has now been successfully rolled out to all areas of the hospital, including the emergency medical unit, emergency department and medical assessment and planning unit, alongside our MET system. The multiple-parameter TTR system has been a useful tool to engage parent medical teams in reviewing patients at risk of critical illness, and has empowered nurses to call for a MET review, given that the modified early warning score provides further evidence that the patient’s condition is deteriorating. With the use of the systems in parallel and the mandatory training package, MET use has doubled and delays in calling for a MET review have decreased.
We would welcome further investigation of the multiple-parameter TTR system that we have adopted, particularly in a multicentre setting.
Competing interests
No relevant disclosures.
References
- Jenkins PF, Thompson CH, Barton LL. Clinical deterioration in the condition of patients with acute medical illness in Australian hospitals: improving detection and response. Med J Aust 2011; 194: 596-598. 0_CHDHFJHC
- Mitchell IA, McKay H, Van Leuvan C, et al. A prospective controlled trial of the effect of a multi-faceted intervention on early recognition and intervention in deteriorating hospital patients. Resuscitation 2010; 81: 658-666. 0_i1142867
- Morgan RJM, Williams F, Wright MM. An early warning scoring system for detecting critical illness. Clin Intensive Care 1997; 8: 1388-1392. 0_CBBICFFI
- Compass. Early Recognition of the Deteriorating Patient Program. Canberra: ACT Health, 2007. http://www.health.act.gov.au/c/health?a=da&did=11025490 (accessed Jun 2010).