MPEWS-Triggered Personalized Care Bundle
Here is a study out of China that evaluated clinical outcomes of children admitted to an "Emergency Observation Unit," or EOU (sounds like an IMC-level of care) who were randomized to 2 groups- standard unit protocols and MPEWS-triggered individualized care. A little background:
Modified Pediatric Early Warning Score (MPEWS) has been proven to predict deterioration risk in pediatric patients. It is based on age-specific vitals (HR, RR, SBP, Temp) and neurologic status (using the AVPU scale). The higher the score, the more likely to clinically deteriorate. Implementation of MPEWS has been proven to decrease the likelihood of deterioration and need for PICU transfer.
What did they do? They took 120 patients, aged <=14, who were admitted to the EOU with MPEWS >=5 (already critically ill, this level is classified as "high risk for deterioration"), 60 of whom received standard care and 60 of whom received "MPEWS-based personalized care." They say that this intervention group got standard care PLUS frequent MPEWS assessments by nursing, early rapid response team involvement, early noninvasive or invasive ventilation, continuous vasoactive support (if indicated by shock states), expedited imaging or procedures, targeted nursing interventions, medication adjustments and daily team huddles. Importantly, its not like the control group was just ignored. They received nearly all of the same things, but just per the unit protocols.
What did they find? Not-so-surprisingly, the intervention group did better. By quite a bit. LOS was 3 days in the intervention group, 4 days in the control group. HR, RR, SBP and O2 sats all improved significantly more rapidly in the intervention group. Complication rates (respiratory failure, shock, and cardiac arrest) were lower across the board in the intervention group. And, for the cherry on top, parent and patient satisfaction was significantly higher in the intervention group.
So what? They claim this is the first study to address MPEWS-based personalized care and demonstrate that this significantly improves outcomes. But we already knew implementation of MPEWS reduces risk of deterioration, probably because this led to early identification and management of a problem (on an individualized basis). Either way, seeing the significant improvement in vital signs and having the objective data is nice (and the graphs are impressive).
Bottom Line: "Continue routine care" may not be the best response when the sepsis alert pops up in EPIC. Early identification of critically ill children is life-saving, and abnormal vital signs should activate your spidey-sense. Early, aggressive, individualized interventions make a big difference.
Modified Pediatric Early Warning Score (MPEWS) has been proven to predict deterioration risk in pediatric patients. It is based on age-specific vitals (HR, RR, SBP, Temp) and neurologic status (using the AVPU scale). The higher the score, the more likely to clinically deteriorate. Implementation of MPEWS has been proven to decrease the likelihood of deterioration and need for PICU transfer.
What did they do? They took 120 patients, aged <=14, who were admitted to the EOU with MPEWS >=5 (already critically ill, this level is classified as "high risk for deterioration"), 60 of whom received standard care and 60 of whom received "MPEWS-based personalized care." They say that this intervention group got standard care PLUS frequent MPEWS assessments by nursing, early rapid response team involvement, early noninvasive or invasive ventilation, continuous vasoactive support (if indicated by shock states), expedited imaging or procedures, targeted nursing interventions, medication adjustments and daily team huddles. Importantly, its not like the control group was just ignored. They received nearly all of the same things, but just per the unit protocols.
What did they find? Not-so-surprisingly, the intervention group did better. By quite a bit. LOS was 3 days in the intervention group, 4 days in the control group. HR, RR, SBP and O2 sats all improved significantly more rapidly in the intervention group. Complication rates (respiratory failure, shock, and cardiac arrest) were lower across the board in the intervention group. And, for the cherry on top, parent and patient satisfaction was significantly higher in the intervention group.
So what? They claim this is the first study to address MPEWS-based personalized care and demonstrate that this significantly improves outcomes. But we already knew implementation of MPEWS reduces risk of deterioration, probably because this led to early identification and management of a problem (on an individualized basis). Either way, seeing the significant improvement in vital signs and having the objective data is nice (and the graphs are impressive).
Bottom Line: "Continue routine care" may not be the best response when the sepsis alert pops up in EPIC. Early identification of critically ill children is life-saving, and abnormal vital signs should activate your spidey-sense. Early, aggressive, individualized interventions make a big difference.
