MEWS to e-MEWS: From a paper-based to an electronic Clinical decision support system

It is now well established that many patients already in hospital can suddenly become acutely ill but experience delayed recognition of their physiological deterioration resulting in late referral to critical care or in some cases death. In recent years there has been significant growth in the use of scorecards to assist with the detection of patient deterioration, but even though a scorecard may be well-constructed and its parameters chosen with the utmost care, the usefulness of any scorecard is only as good as the accuracy and timeliness of the data that is used to populate it. The Modified Early Warning Scorecard (MEWS) is a paper-based medical scorecard application, which is intended to provide clinicians with an early warning of acute patient deterioration. While it is a significant advance in patient care, major data capture and processing deficiencies exist within thepaper-based MEWS system. Presented in this paper is the electronic MEWS (e-MEWS) which has been developed by the authors of this paper. The e-MEWS is a rule-based clinical decision support system (CDSS) designed to automatically perform frequent wireless monitoring of a patient's vital signs and process the data to calculate and display a MEWS score and other valuable patient information. The research presents a unique application of IS to a real-world problem which required collaboration from several disciplines; Information systems, Medicine, and Engineering. To validate the approach that was followed by this research a workshop which involved the participation of 51 medical staff was held in St. Luke's hospital, Kilkenny, Ireland, where the paper-based MEWS has been in use for almost 6 years. To validate the operation of the e-MEWS system a clinical trial was conducted in the stroke unit of St. Luke's. It is clear from our findings that the e-MEWS system will enable clinicians to identify patients at risk much earlier, will greatly improve patient care, and will gain wide acceptance among medical and nursing staff.