Use of the Modified Early Warning Score and Serum Lactate to Prevent Cardiopulmonary Arrest in Hematology-Oncology Patients: A Quality Improvement Study

Robert S. Young*, Barbara H. Gobel, Mark Schumacher, Jungwha Lee, Charlotta Weaver, Sigmund Weitzman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

This process improvement project aimed to improve the early identification of clinically deteriorating hematology-oncology patients in order to prevent the development of critical illness and to facilitate timely intensive care unit (ICU) transfers. Using failure modes and effects analysis, a protocol employing the Modified Early Warning Score and serum lactate level was implemented to identify deteriorating patients who required the attention of the rapid response team. Control charts revealed a significant decrease in codes and preventable codes, while ICU transfers remained stable. A retrospective analysis to control for age, sex, race, severity of illness, and do not resuscitate status was performed, yielding a codes odds ratio of 0.51 (95% confidence interval = 0.31-0.85) and a preventable codes odds ratio of 0.25 (95% confidence interval = 0.07-0.82). At the study team’s institution, implementation of this protocol reduced codes and preventable codes without an associated increase in ICU transfers.

Original languageEnglish (US)
Pages (from-to)530-537
Number of pages8
JournalAmerican Journal of Medical Quality
Volume29
Issue number6
DOIs
StatePublished - Jan 1 2014

Keywords

  • clinical deterioration
  • modified early warning score
  • oncology care
  • serum lactate

ASJC Scopus subject areas

  • Health Policy

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