Utilization of an Early Warning Score to Initiate Proactive Rounding by the Rapid Response Team

Millions of adverse events, including failure to rescue (FTR), occur around the world each year leading to increasing hospital length of stay, increasing mortality, and decreasing quality of life. FTR events happen when mortality occurs following a major medical complication. With the assistance of electronic early identification of clinical deterioration, interventions may be implemented to decrease FTR events.
This project was guided by the PICO question: In adult medical-surgical inpatients, does proactive rounding by the rapid response team with utilization of an automated early warning system, compared with no proactive rounding, improve recognition of clinical deterioration, and decrease transfers to critical care? A REDCap database was built and utilized to track proactive rounding along with Modified Early Warning Scores (MEWS) by the Critical Care Code Team at a tertiary medical center and compared to rapid response and code blue activations. The percentage of transfers to critical care from quarter four of 2022 to quarter four of 2023 was then compared using a paired T-Test to determine statistical significance.
A proactive rounding process was developed, and 664 rounds were entered. Of these, 114 were proactive rounds with the utilization of MEWS and 550 were non-proactive rounds. Rounding triggers were compared and analyzed which revealed that the primary reason for rounding was staff concerns, and that collaboration was important to improve patient outcomes. There was a decrease in transfers to critical care post rapid responses, however it was not statistically significant. Implementation of proactive rounding could be useful to decrease length of stay, decrease hospital mortality, and improve patient satisfaction.