STRENGTHENING EMERGENCY RESPONSE SYSTEMS THROUGH MEWS-BASED SURVEILLANCE AND INTENSIVIST-LED MEDICAL

Average return ICU admission rate within 48 hours of ICU transfer of last 6 months
was observed at 1.09%. Analysis revealed:

• Most patients fulfilled ICU discharge criteria.
• Clinical deterioration occurred after transfer to the ward.
• Early warning signs were often subtle.
• Existing systems were largely reactive and activated after significant deterioration.

• To establish a proactive surveillance system for high-risk patients and reduce preventable clinical deterioration through early recognition and intervention.
• To achieve ≥90% compliance with proactive surveillance rounds for identified high-risk patients and reduce unplanned ICU transfers by 20% within 12 months.

Discharge Assessment

• A structured ICU discharge checklist was implemented and audited. • Outcome: ICU discharge decisions were found appropriate and standardized.

Phase 2: Intensivist-led Medical Emergency Team (MET) Rounds

• A proactive surveillance model was introduced.
• Patients included:
• ICU step-down patients
• Elevated MEWS patients
• Potential ICU transfer candidates
• Elderly patients
• Clinically vulnerable patients
• Staff-identified high-risk patients

Innovation

Traditional Emergency Response Systems function after deterioration occurs. Our model introduced: “Deterioration Prevention Rounds”. Rather than waiting for Code Blue activation for Cardiac arrest and Emergency ICU transfer, the MET proactively identified for vulnerable patients and intervened before crisis occurred.

Team

Clinical Outcomes

Following the implementation of proactive MET rounds, the Return to ICU rate decreased from 1.09% to 0.50%, representing a 54.1% reduction.

Additional outcomes observed included:
• Significant reduction in unplanned return ICU admissions.
• Decrease in ward-based emergency events requiring urgent intervention.
• Earlier recognition and management of clinically deteriorating patients.
• Improvement in key patient safety indicators.
• Reduction in avoidable adverse events through timely escalation and intervention.

Key Result: The proactive surveillance model led to a 54.1% reduction in Return to ICU admissions, demonstrating the effectiveness of early identification and intervention in high-risk patients.

Balancing Measures
• No increase in inappropriate ICU admissions
• No increase in ICU length of stay
• Improved clinician confidence in patient transfer decisions

Sustainability

The initiative has been integrated into routine hospital operations through:
• Daily MET rounds
• MEWS monitoring
• Intensivist leadership
• Standard operating procedures
• Monthly audit review
• Medical Audit Committee oversight

Impact

The project established a continuous safety net extending beyond ICU discharge and strengthened the hospital’s Emergency Response System. By combining MEWS surveillance with Intensivist-led MET rounds, the organization successfully shifted from emergency response to deterioration prevention.

Challenges

Ensuring consistent MEWS scoring, timely escalation, staff awareness, and effective communication between ICU and ward teams.

1. Getting all nursing staff to consistently assess and document MEWS scores.
2. Ensuring timely escalation when a patient’s condition started deteriorating.
3. Creating awareness among ward staff about the importance of early recognition of deterioration.
4. Coordinating daily MET rounds without affecting routine clinical work.
5. Ensuring proper communication during ICU-to-ward transfers.
6. Overcoming hesitation among staff to call for help or escalate concerns early.
7. Maintaining compliance with surveillance and documentation processes.

Critical Success Factors

1. Active nursing participation in MEWS monitoring, prompt escalation, daily MET rounds, multidisciplinary teamwork, clear communication, and strong leadership support.
2. Active involvement of nursing staff in regular MEWS assessment and monitoring.
3. Timely escalation of patients with abnormal MEWS scores or clinical concerns.
4. Daily Intensivist-led MET rounds for early identification of at-risk patients.
5. Strong support from hospital leadership and clinical teams.
6. Clear escalation protocol, making it easy for staff to know whom to contact and w

1. Early identification saves lives – Patients showing early signs of deterioration can be stabilized before a serious event occurs.
2. MEWS is an effective tool for identifying high-risk patients and triggering timely intervention.
3. Timely escalation is crucial – Delays in communicating concerns can lead to avoidable deterioration and ICU readmissions.
4. Daily proactive rounds are more effective than reactive management, as they help identify problems before they become emergencies.
5. Nursing staff play a critical role in patient safety through regular monitoring, documentation, and escalation.
6. Effective communication during ICU-to-ward transfer is essential to ensure continuity of care.
7. Multidisciplinary collaboration between nurses, physicians, Intensivists, and the Quality team improves patient outcomes.
8. Standardized processes reduce variation and ensure consistent management of high-risk patients. Continuous monitoring and feedback help sustain compliance and drive ongoing improvement.
9. A culture of speaking up and escalating concerns early enhances patient safety and reduces preventable.