Thinking by proxy

At my workplace we have recently implemented the Modified Early Warning Score (MEWS) to assist clinicians to decide if their patients are unwell or not.  On the surface of it, you would think this is a great idea, especially as it empowers junior staff to call senior staff to review patients they are concerned about.  Given my interest in the role or rational thinking in healthcare, my view is less positive.

I have no problem with the MEWS being used as a tool to quantify your concern about a patient, even though there are times when you are concerned despite the observations appearing OK (and hence the MEWS is OK).  What I have serious doubts about is staff using MEWS to decide whether they should be concerned!!  If you need a score on a sheet of paper to decide if your patient is unwell, you probably should find another line of work.

Using the MEWS in the Emergency Department makes no sense.  It merely adds another task to the list, with little likelihood of impacting on patient outcomes.  This is especially true when there are no policies in place to govern the use of MEWS in this setting.  Say a patient has a MEWS of 8, so what?  We will already be implementing emergency care to deal with whatever the problem is, so what are we adding to the equation?  If the MEWS is supposed to guide the level of response such as Triage Category, them I'm getting really worried.  Allocating triage categories and directing ED resources is a specialised skill, and should not be done by inexperienced staff, so I can't see how using MEWS is going to improve anything in the ED.

However, because someone higher up the food chain than the frontline staff has decided that MEWS is the best thing since sliced bread, it seems that it is here to stay.  Its use is even being audited, which is quite funny is a sad way.  Since it has no bearing on patient outcomes in the ED, auditing its use is a waste of resources.  If we're going to audit it at all, we should audit its efficacy not just whether it is being used!!