| Objective:To access the value of a emergency critical care protocol based on Modified Early Warning Score(MEWS)on the impact of illness and in the allocation and the use of the emergency critical care resources by comparing the differences between the protocol and conventional emergency critical care.Methods:The study subject comprised the medical and surgical adult patients in the emergency department of Xiangya hospital in Central South University between August 2006 and January 2008.All enrolled patients were randomly assigned to intervention group or control group. The patients in the control group received the conventional emergency critical care,the patients in the intervention group received a procedural protocol of emergency critical care designed in this study.The main features of the protocol are:1)A series of different classes of emergency critical care plans were pre-designed,each class of plans would be triggered by a MEWS score pre-established;2)The content of each class included on the frequency of monitoring patients' vital signs,a MEWS score can be obtained by vital signs,if the MEWS score reached a trigger value,the corresponding class of plans would be launched immediately.3) When a patient was admitted into emergency department,various classes of plans would be launched automatically one after the other according to MEWS,resulting in the procedural critical care process.To compare the differences of accident event rate,APACHEⅡscore,staying time,rate of admission to special ward,mortality of 30 days and the frequency of monitoring patients' vital signs during the period of emergency observation between the intervention group and the control group.Results:During the study period,550 cases were enrolled,132 cases were excluded in accordance with criteria for exclusion,a total of 418 cases completed the study,and there were 207 cases in the intervention group and 211 cases in the control group.The results show that:1)The accident events occurred in the intervention group(19.8%)was significantly lower than in the control group(30.8%)(χ~2=6.68,P＜0.01).2) APACHEⅡscore when patients discharged from emergency department was no significant difference between the intervention group(11.26±6.32) and the control group(11.33±6.35)(u=0.11,P＞0.5).3)The staying time in the intervention group(3.74±2.76days)was less than that in the control group(4.30±2.91days)(u=2.01,P＜0.05).4)Rate of admission to special wards was 29.5%in the intervention group and 28.0%in the control group,there was no significant difference(χ~2=0.12,P＞0.5).5)Mortality of 30 days was 10.6%in the intervention group and 9.0%in the control group,there was no significant difference(χ~2=0.31,P＞0.5).6)The frequencies of monitoring patients' vital signs in the initial 24-hour were much more in the intervention group(24.02±9.32)than those in the control group(10.78±3.23)(u=19.33,P＜0.001).During the whole period of emergency observation,the frequencies in the intervention group (40.06±16.23)were less than those in the control group(45.55±12.73) (u=3.84,P＜0.001).Conclusions:1)The emergency critical care protocol based on MEWS is feasible,whose characteristic is the simple and quick in clinical trial.2)The emergency critical care protocol based on MEWS can reduce the accident events rate,shorten the time for patients to stay in emergency observation ward in this study.3)The emergency critical care protocol based on MEWS might be favorable to allocate and make use of emergency critical care resources rationally.
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