Dissertation
Addressing unplanned escalations of care to the trauma ICU: the impact of the Modified Early Warning Score
Doctor of Nursing Practice (D.N.P.), Drexel University
16 May 2026
DOI:
https://doi.org/10.17918/00011357
Abstract
Background: Unplanned escalations of care to the ICU is a critical concern in healthcare settings, with early recognition of clinical deterioration being paramount. The Modified Early Warning Score (MEWS) protocol aims to enhance early detection of patient deterioration and thereby reduce the rate of unplanned escalations. Local Problem: This DNP project addresses the high incidence of unplanned ICU transfers at a Mid-Atlantic urban trauma center, driven by delays in identifying deteriorating patients. Methods: Utilizing a rapid cycle quality improvement approach, the project involved training trauma nurses on MEWS implementation over six weeks. Compliance and outcome measures were evaluated through chart audits and data analysis. Interventions: Key strategies included staff education, real-time feedback, and integration of MEWS into electronic medical records. Results: While there was no statistically significant difference in escalation rates between the historical group and the current group, with a p-value of 0.311, there was a significant reduction in nurse-to-provider notification times, from a mean of 39.73 minutes in the historical group to 20.38 minutes in the current group (p < 0.001), which indicated clinical significance. Conclusions: The implementation of the MEWS protocol, despite not achieving statistical significance, resulted in a clinically significant reduction in nurse-to-provider notification times and improved compliance, highlighting its potential to enhance early identification of patient deterioration and thus improve quality of care. Keywords: Modified Early Warning Score, unplanned escalation, quality improvement, ICU transfers, early identification.
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Details
- Title
- Addressing unplanned escalations of care to the trauma ICU
- Creators
- Pauline Heiden - Drexel University, Doctoral Nursing
- Contributors
- Barbara Ruth Osborne (DNP Chair) - Drexel University, Nurse Practitioner Master of Science in Nursing (MSN)
- Awarding Institution
- Drexel University
- Degree Awarded
- Doctor of Nursing Practice (D.N.P.)
- Publisher
- Drexel University
- Number of pages
- 49 pages
- Resource Type
- Dissertation
- Language
- English
- Academic Unit
- Doctoral Nursing; Nursing (Graduate); College of Nursing and Health Professions; Drexel University
- Other Identifier
- 991022181776004721