SMARTMEWS H@H

1. Rapid Respons Team works?
Reduction of cardiac arrests in hospitals in non-ICU area of 50% Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV,
Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study, BMJ
2002; 324: 387-390
Reduction of admission in PACU (58%) and deaths (37%) Bellomo R, Goldsmith D, Uchino S, et al. Prospective controlled trial of effect of medical
emergency team on postoperative morbidity and mortality rates, Crit Care Med. 2004; 32: 916-921
Reduction of cardiac arrests before admission to ICU (4% vs 30%) Goldhill DR, Worthington L, Mulcahy A, Tarling M, Sumner A, The patient-at-
risk team: identifying and managing seriously ill ward patients, Anesthesia. 1999; 54(9): 853-860
17% reduction of cardiac arrests (6,5 vs 5,4 per 1000 admissions) De Vita MA, Braithwaite RS, Mahidhara R, Stuart S, Foraida M, Simmons RL, Use of
medical emergency team responses to reduce hospital cardiopulmonary arrests, Qual Saf Health Care. 2004; 13(4): 251-254
It is for this reason that the international
literature available on the subject and
the most recent worldwide guidelines for
cardiopulmonary resuscitation are aimed
at the prevention of the cardiac arrest
by recognising the signs and symptoms
that precede this extreme situation and
the appropriate treatment. The different
models developed in the world to respond
to this type of need have recently been
systemised into an implementational
rapid response for emergencies called
Rapid Response System (RRS).
It is characterised by an “afferent arm”
that can intercept the event acutely,
and trigger a response based on the
predefined criteria with an “efferent arm”
consisting of highly qualified emergency
response personnel and intensive care
(Medical Emergency Team MET) with
an adequate data collection system.
The personnel in the wards must
be able to monitor admitted patients
with adequate instruments such as:
and scoring system for monitoring
a patient’s condition and increases
the attention to the patient, and when
necessary, allows for timely activation of
the MET (Medical Emergency Team. The
MEWS, Modified Early Warning Score,
provides an assessment of the systolic
blood pressure, heart rate, respiratory
rate, body temperature and level of
consciousness using AVPU (Alert, Verbal,
Pain, Unresponsive) allows for the early
identification of deteriorating vital signs;
it allows for the early detection of the
various stages of SEPSIS (SUSPECTED
SEPSIS; DOCUMENTED SEPSIS;
SEVERE SEPSIS; SEPSIS SHOCK)
thanks to the interpolation of data from:
the patients clinical condition /
physiological parameters / blood
clinical prediction rule used to assess
risk of adverse outcomes in patients
presenting with pulmonary embolism.
This score is calculated on the basis of
the clinical information and physiological
parameters of the patient. Based on
this score, the patient is assigned a
degree of risk: Grade I Very low risk:
0-1.6% 30-day mortality / Grade II Low
risk: 1.7-3.5% 30-day mortality / Grade
III Intermediate Risk: 3.2-7.1% 30-day
mortality / Grade IV High Risk: 4.0-11.4%
30-day mortality / Grade V Very high risk:
early recognition of haemorrhagic shock,
and its effects on the outcome have
long been recognized. Traditional vital
signs are relatively insensitive as early
diagnostic markers of haemorrhaging,
and as a result, the shock index (SI) -
heart rate (HR) divided by systolic blood
pressure (SBP) - has been suggested
as more sensitive marker. The response
team is activated by the “Track&Trigger”
system, depending on the MEWS score
obtained. In addition, the Sepsis/Severe
Sepsis screening tool and PESI is an
indispensable tool for recognizing and
promptly addressing the critical situations
introduced by SEPSIS and pulmonary
Embolism and haemorrhaging.
The hospital may paradoxically fail in its overall management of critical events
ranging from sudden deterioration, more or less rapid, of general conditions
to cardiac arrest. The situation is often manifested by late intervention, be it
resuscitation of a patient in their bed, in surgery or in the intensive care unit.
Within hospitals the mortality rate from sudden cardiac arrests remains high.
The incidents, based on the data of international literature, is between 1– 5%
admissions/year or 0.175 beds/year (Hodgetts, Resuscitation 2002 – Peberdy,
Resuscitation 2003).
Much of the literature highlights that the prognosis of the intrahospital cardiac
arrests, despite all the organisational efforts aimed at implementing an optimal
response model, is still too often unfavourable; the survival rate for hospital
discharge, worldwide, was about 14 – 18% for many years.
Patients developing an arrest in the hospitals general ward services have
predominantly shown respiratory and metabolic derangements immediately
preceding their arrest. Arrests are also frequently preceded by a clinical
deterioration involving either respiratory or mental function.
The cardiac arrest, whilst representing the final stage of the most morbid events,
must not be regarded as inevitable: the intrahospital cardiac arrest that occurs
with normal hospitalised patients is not a sudden cardiac death in the majority of
cases. Preceding this, in 75 – 80% of the cases there are abnormal physiological
parameters and it is therefore potentially avoidable; the signs of clinical
deterioration that evolve rapidly relating the cardiac arrest are present at least
eight hours before the cardiac arrest and it is therefore essential to recognise
them immediately.
Bellomo R, Goldsmith D, Uchino S, et al. A prospective before-and-after trial of a medical emergency team, Med J
Aust. 2003, 179(6): 283‐287; The incidence of in-hospital cardiac arrest and death following cardiac arrest decreased
after introduction of an intensive-care-based medical emergency team, as did overall hospital mortality
Before
63
37
163
1363
302
After
22
16
33
159
222
RRR 65% p=0,001
RRR 56% p=0,005
RRR 80% p=0,001
RRR 88% p=0,001
RRR 26% p=0,004
RRT Results
C.A.s number
C.A.s deaths
Total L.O.S. in ICU post-CA
Total L.O.S. in hospital Post-CA
Deaths during admissions
The most sophisticated intensive
care often becomes unnecessarily
expensive terminal care when the
pre-ICU system fails
Peter Safar, 1974
80% of patients who experience
an in-hospital cardiac arrest have
changes in vital signs eight hours
prior to the event
Schein RMH. Chest 1990;
98:1388‐1392
chemistry analysis •The Pulmonary
Embolism Severity Index (PESI) is a
M.E.W.S.• MEWS – the MEWS (Modified Early
Warning Score) model is a data collection
Sepsis Screening Tool
P.E.S.I.
Shock Index
10.0-24.5% 30-day mortality• Shock
Index is an important indicator for the
• Sepsis / Severe Sepsis screening tool:
INTRODUCTION TO SMARTMEWS

2. Track and Trigger.
BRH@H_SM_rev01
MADE IN
ITALY
INNOVATION OF THE DEVICE
The H@H SMARTMEWS integrated system is the most
advanced device in terms of medical technology for remote
monitoring of vital signs and clinical data collection.
It represents the evolution of telemedicine with remote
monitoring of vital signs and the collection of clinical data;
facilitating the diffusion and the information for physicians,
researchers and patients and offering direct care via the
telemedicine device.
The device incorporates one multi parameter monitor (ECG,
SaPO2 , Respiratory Rate - RR, two Temperature channels –
T°, one channel for Non Invasive Blood Pressure measurement
– NIBP), a complete computerized clinical chart that is able
to be compiled and edited, as well as some automatic scores
(Modified Early Warning Score – MEWS, Sepsis/Severe Sepsis
screening tool, PESI, Shock Index, Glasgow Coma Scale –
GCS, Glasgow Outcome Scale – GOS, Coma Recovery Scale-
Revised – CRS-R, Sequential Organ Failure Assessment score
Track and Trigger.
H@H s.r.l.
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t +39 080 3143647
f +39 080 3160611
www.hospitalathome.it
info@hospitalathome.it
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H@H s.r.l., H@H smart mews and ITEM OXYGEN s.r.l. are registered trademarks.
No part of this publication may be reproduced or used without authorization from H@H.
Patented device and design.
in high definition. All the devices are connected via an intranet
and centralised in the H@H SMARTMEWS Central Station
in Intensive Care. The data obtained by monitoring the vital
signs, processed with the information in the Computerised
then automatically sends alerts depending on the status of the
various scores. Each of the H.R., R.R., SaPO2, T°, NIBP values
are assigned a MEWS based score that is then totalled; if
below 5 standard assistance protocol for the ward are applied,
if => 6 the Service Centre in Intensive Care is alerted and it
activates (Trigger) the RRT (Rapid Response Team), made up
of a anaesthetist and Intensive Care nurse, who immediately
attend to the critical patient. This system creates extremely
positive feedback in terms of mortality and morbidity as
described in the literature, as we have seen, serious adverse
events are pronounced at least 8 hours before they are
– SOFA Score etc.).
Finally there is a channel for video communication
Central Station screeNnshots of H@H SMARTMEWS
are automatically processed by the onboard computer that
determined by significant changes in vital signs
Medical Chart through a process called “Track and Trigger”,