UC Irvine

Delayed recognition of patient deterioration in acute care settings is associated with increased morbidity, mortality, unplanned transfers to higher levels of care, and failure to rescue. Early warning systems, such as the Modified Early Warning Score (MEWS), provide standardized criteria to identify at-risk patients and facilitate earlier escalation of care, including activation of the Rapid Response Team (RRT). Despite evidence supporting MEWS, staff awareness and consistent utilization remain variable, highlighting the need for targeted education and structured implementation. This quality improvement project aimed to enhance early recognition of patient deterioration and improve outcomes in a Level II trauma center observation unit in Southern California. The intervention included standardized staff education on MEWS scoring and escalation protocols, reinforcement of MEWS use and RRT activation, and provision of MEWS reference tools. During the 7-week implementation period, MEWS use and adherence were evaluated through periodic audits to ensure accurate scoring and appropriate RRT activation. Primary outcomes, including RRT activations, code blue events, and transfers to higher levels of care, were collected from the electronic medical record. Nurse confidence in recognizing and escalating patient deterioration was assessed using pre- and post-intervention surveys. Implementation fidelity was monitored through periodic chart audits. Post-intervention survey results are pending. Anticipated outcomes include increased RRT activation, improved nurse confidence, and a reduction in adverse events. Findings from this quality improvement project support ongoing implementation, with integration of MEWS into the electronic medical record currently in progress and expected to be implemented hospital wide.