Respiratory failure & ventilation
Transition from mandatory to discretionary nurse-measured Modified Early Warning Score (MEWS) assessment in a continuously monitored surgical ward: Diagnostic performance of wearable-derived early warning scores
Authors' conclusion
In a surgical ward where continuous wearable monitoring was already available, transition from mandatory to discretionary nurse-measured MEWS assessment was associated with fewer intermittent observations, higher MEWS sensitivity, and lower specificity. Wearable-derived EWS algorithms showed comparable but modest discriminative performance relative to conventional MEWS.
Study context
- Population
- Postoperative patients on a surgical ward continuously monitored with a wearable sensor (heart rate, respiratory rate, oxygen saturation), October 2024–June 2025admissions (516 patients)
- Participants
- 544 patients
- Comparison
- MEWS vs Continuous Remote EWS (CREWS) vs R3EWS
- Outcome
- Diagnostic accuracy for clinical deterioration (postoperative complications Clavien-Dindo ≥ II)
Methodological detailssingle-centre, cohort, before-after (mandatory vs discretionary nurse-measured MEWS)
- Single-centre
- Cohort
- Before-after (mandatory vs discretionary nurse-measured MEWS)
Performance
As reported in the abstract
Diagnostic accuracy for clinical deterioration
| Test or model | AUROC |
|---|---|
| MEWS | 0.58 |
| CREWS | 0.59 |
| R3EWS | 0.61 |
AUROC
MEWS0.58
CREWS0.59
R3EWS0.61
Further findings
Clinical deterioration
- Admissions with clinical deterioration
- 98 (18%)
- Clinical deterioration events
- 154
Mandatory vs discretionary nurse-measured MEWS assessment
- After transition to discretionary: intermittent nurse-measured vital signs less frequent, MEWS ≥ 3 more often, higher MEWS sensitivity and lower specificity
Wearable-derived alarm frequency · 6-8 h before clinical deterioration
- Alarm frequency increased before clinical deterioration
Original publication
Transition from mandatory to discretionary nurse-measured MEWS assessment in a continuously monitored surgical ward: Diagnostic performance of wearable-derived early warning scores. J Clin Monit Comput. Published 29 August 2026. doi:10.
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