1. Sandhu, Emma J. BSN, RN, CCRN

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As manager of a pediatric ICU and chair of our facility's code committee, I implemented the rapid response program in our facility ("Hospital System Barriers to Rapid Response Team Activation: A Cognitive Work Analysis," February).


One thing that helped to eliminate the barriers and stigma of calling for help was the implementation of an early warning assessment, PEWS (Pediatric Early Warning System). Objective data from an early detection intervention such as PEWS or MEWS (Modified Early Warning Score) can be more reliable than clinical judgment alone in the detection of subtle changes in a patient's condition.1


Nurses, however, tend to frown upon additional documentation requirements. One alternative worth exploring is the use of automated, computerized data collection software that can analyze electronic medical records (EMR) and help predict clinical deterioration. The numeric computations and early warning score provided by the Rothman Index, for example, is based on changes documented in the patient's EMR and can thereby eliminate subjectivity and stigma.2


It's possible that the incorporation of new evidence-based tools can make the decision to call a rapid response team an easy one.


Emma J. Sandhu, BSN, RN, CCRN


Mission Viejo, CA




1. Fullerton JN, et al. Is the modified early warning score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment? Resuscitation. 2012;83(5):557-62 [Context Link]


2. Finlay GD, et al. Measuring the modified early warning score and the Rothman index: advantages of utilizing the electronic medical record in an early warning system J Hosp Med. 2014;9(2):116-9 [Context Link]