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Data Analytics Part II

Ashley Bryan

School of Health Professions and Wellness, Jacksonville State University

DNP 716: Interprofessional Healthcare and Informatics

Dr. Arlinda Wormely

July 14, 2022

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Data Analytics Part II

Clinical Gap in Service

Modified Early Warning Scores

The modified early warning scores (MEWS) are for clinical deterioration. MEWS

determines the degree of illness of a patient by scoring vital signs to predict a chance of

intensive care unit (ICU) admission or death within 60 days (MDCalc, 2022). The MEWS tool

was created and used regularly to identify patients at risk for deterioration (MDCalc, 2022).

MEWS is used by any healthcare worker that has received proper training on utilizing and

interpreting the results (MDCalc, 2022).

An elevated MEWS during a rapid response is a valid predictor for admission to an

intensive care unit (ICU) during patient deterioration (Kirsch et al., 2020). A MEWS of 4 has a

12.7% chance of ICU admission or death within 60 days (MDCalc, 2022). A MEWS of 5 has a

30% chance of ICU admission or death within 60 days and recommends considering a higher

level of care (MDCalc, 2022).

Current Practice Data Analysis

The current practice for the facility is for rapid response activation after a medical

emergency has occurred. Over the last three months, the facility has had 114 rapid responses

total (Bryan et al., 2022). Current data at the facility shows 25.6% of unplanned admissions to

ICU after a rapid response (Bryan et al., 2022).

Gap in Service

While hospitalized, a patient with an acute deterioration will often show warning signs

(abnormal vital signs) hours before experiencing an adverse clinical outcome (Patient Safety
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Data Analytics Part II

Network, 2019). The gap in service at the facility is not utilizing the MEWS system to proactively

round on patients to prevent unplanned ICU admission. An elevated MEWS resulted in

unplanned ICU admission, resulting in a nearly 3-fold increased mortality risk (Kirsch et al.,

2020). Evidence-based practice shows that rapid response teams reduce total ICU admissions,

average ICU occupancy rate, hospital mortality, and ICU mortality (Al-Omari et al., 2019).

Data Needs

The facility currently utilizes an excel spreadsheet to import data from rapid responses

for tracking purposes. Baseline data collected on the rapid response data tracking excel sheet

include shift, location, call type, transfer to a higher level of care, and additional comments. Call

types include code blue, rapid response, SIRS, phlebotomy/IV, follow-up, telemetry escalation,

and others. During the implementation of the DNP project, MEWS will be added under the call

type. Post-implementation data will show the outcome of the DNP project to identify if the

implementation of MEWS decreased ICU admissions.

Data Sources

Potential sources of data needed for the DNP project include information obtained from

an electronic health record (EHR). The facility where the DNP project will occur utilizes the Epic

EHR software. Epic Hyperspace has the ability for rapid response teams to see a patient list of

MEWS >4. The DNP project aims to implement MEWS as a part of the rapid response program

with a goal to decrease unplanned ICU admissions.

The DNP project has the possibility of improved hospital consumer assessment of

healthcare providers and systems (HCAHPS) by improving patient satisfaction with proactive

rounding with MEWS by intervening before clinical deterioration. Revenue could be decreased

by intervening before clinical deterioration. Texas A&M University completed a comprehensive

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Data Analytics Part II

analysis of hospitalization costs and outcomes that showed the median length of stay was five

days with a median total cost of $13,443 and a median cost per day of $2,902 (Tucker, 2022).

Staff satisfaction and retention could improve due to earlier assistance with deteriorating

patients. The DNP project could show improvement in the sources mentioned above. However,

the project measured goal will be unplanned ICU admissions.

Data Acquisition and Access

Data needed for the DNP project is obtained from rapid response reports. The data is

collected and imported into a Microsoft Excel spreadsheet. The Microsoft Excel spreadsheet is

set up for rapid response data collection. The document is a live Microsoft Excel spreadsheet

stored on the Wellstar Health system network. The facility's house supervisors and rapid

response team maintain the data. The data is accessed by the author, the facility's house

supervisors, rapid response teams, and administrative leaders. The facility's nursing

administration oversees the data and controls who is allowed to access the data (Bryan et al.,

2022).

Conclusion

In conclusion, the identified clinical gap in practice is not utilizing MEWS as a part of the

rapid response team. The MEWS tool was created and used regularly to identify patients at risk

for deterioration (MDCalc, 2022). The DNP project aims to decrease unplanned ICU admissions

by implementing MEWS for rapid response teams. The DNP project data is obtained from a

Microsoft Excel spreadsheet maintained by the house supervisor and rapid response team. The

data is sourced from the rapid responses documented in the Epic EHR. The author and peers

collect, maintain, and access data at the facility where the DNP project will take place (Bryan et

al., 2022).
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Data Analytics Part II
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Data Analytics Part II

References

Al-Omari, A., Mutair, A., Aljamaan, F. (2019). Outcomes of rapid response team implementation

in tertiary private hospitals: a prospective cohort study. International Journal of

Emergency Medicine (12)31, 1-5. https://doi.org/10.1186/s12245-019-0248-5

Bryan, A., Head, D., Black, K., Davis, M. Ellenburg, A., Puckett, J. Kleiman, R., (2022). Rapid

response data tracking. Microsoft Excel. Wellstar Health System.

https://wellstarhealthsystem.org

Tucker, K. (2022). Study: COVID-19 hospitalization costs, outcomes in 2020 improved over

time. Texas A&M University School of Public Health.

https://today.tamu.edu/2022/01/03/study-covid-19-hospitalization-costs-outcomes-in-

2020-improved-over-time/

Kirsch, N. Bessen, M., Warren, M., Cross, C., Dy, R. (2020). The modified early warning score

(MEWS) as a predictor of unanticipated ICU admission at the time of rapid response.

Chest Journal. https://doi.org/10.1016/j.chest.2020.08.603

MDCalc. (2022). Modified early warning score (MEWS) for clinical deterioration.

https://www.mdcalc.com/modified-early-warning-score-mews-clinical-deterioration

Patient Safety Network. (2019). Rapid response systems. Agency for Healthcare Research and

Quality. https://psnet.ahrq.gov/primer/rapid-response-systems