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In This Issue
Message from the CMO
Children's Hospital of San Antonio News
Ethics: Today's Hot Topics
Modified Early Warning Score (MEWS)
Upcoming Educational Activities

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Message from the CMO


Children's Hospital of San Antonio


Locating MEWS in the EMR


MEWS Calculation


CME Calendar

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 December 2012



Please take some time to read the important information provided in the articles below.  Thank you again for being our physican partners, and many blessings to you for a wonderful holiday season!

Message from the CMO

"Grieving the Changes of Medicine"

(with apologies to Dr. Kübler-Ross)Jim Martin, MD


As predicted, the intentional and unintentional effects of healthcare reform are now impacting all of us. I have repeatedly heard the following:

  • "Sit back and relax; they tried this in the 90's, and it failed then and will now."
  • "I hate Obamacare."
  • "I will try to keep doing the same thing for a couple of more years and then retire before being forced to change."
  • "I would not encourage anybody to go into Medicine as a career. The joy of Medicine has been lost."

In my many meetings with our colleagues, those comments reminded me of Dr. Kübler- Ross and her five stages of grief.


The changes in Medicine are producing the same grieving stages and will require the same work for us to come out healthy. Below is a self assessment to determine where each of us is and what effort will need to be done to be successful in completing that journey.


Read on 

Children's Hospital of San Antonio News




Children's Hospital of San Antonio has signed letters of intent with Texas Children's Hospital and Baylor College of Medicine, and we are working closely with both institutions as consultants for space planning, program development and medical staff recruitment needs.  


Dr. Gordon Schutze has been appointed Interim Pediatrician in Chief of the Children's Hospital of San Antonio. He will be on-site two days a week assisting with administrative issues, physician recruitment, quality improvement efforts and "other duties as assigned".


Read on


To follow our story please visit



Many physicians have shared with CHRISTUS Informatics concerns about processing time that slows physician workflow when using MEDITECH and CPOM.  Physicians have reported experiencing brief delays and the system not responding immediately when confirming and clicking a particular action. 


We wish to assure you that Regional leadership is fully aware of this critical issue, and its urgency has been shared with corporate Information Management (IM).  We are pleased to report that an intense effort is now underway to respond to and improve the physician user experience based on the feedback you have provided.  Some of the key efforts engaged by CHRISTUS IM involve:

  • Completing the migration of the MEDITECH software to a new dedicated and more reliable environment.  The recent problems with this migration are being addressed with all possible resources and CHRISTUS IM continues to monitor and optimize MEDITECH's new home.
  • Investments are being made in external consultants from CISCO and IBM who are in the process of finalizing a comprehensive evaluation of the CHRISTUS IT infrastructure and providing reports and recommendations to corporate IM.
  • Additional long-term recommendations are being developed in order to provide for easier expansion of advanced clinical technologies.
  • Evaluation of Virtual Desktop solutions using dedicated workstations or terminals to provide a faster processing experience is being actively explored.
  • Efforts have been engaged to simplify Log in so as to provide faster and secure physician sign-on, for example using a badge on a reader, while maintaining critical information security requirements as mandated by HIPAA.

We will continue to provide progress reports on these efforts and share your feedback with CHRISTUS IM in order to drive significant improvement of your user experience and processing time.
Thank you for your continued support and partnership in optimizing Meditech and CPOM.  For any questions or concerns please contact George Gellert, Regional Medical Informatics Officer.


 Foundations for Change

Ethics:  Today's Hot Topics

Keeping Patients Alive a Few More Weeks: Is it Futile Care?  Click here for video featuring Arthur L. Caplan, PhD


Physicians' Top Ethical Dilemmas: Click here for Medscape 2012 Survey Results

Modified Early Warning Score (MEWS) System is Now Being Used to Determine Change in Condition


Modified Early Warning Scores (MEWS) are commonly used for the assessment of hospital patients in non-Intensive care units. The Early Warning Score is a simple scoring system that can be calculated using parameters which are measured for all acute patients. It can be used to quickly identify patients who are clinically deteriorating and who need urgent intervention.


MEWS is now being used to monitor medical and surgical patients over 18 years of age, in each of the CHRISTUS Santa Rosa adult facilitiesThe score is entered in the EMR.


The use of MEWS has been shown to be effective in reducing mortality and morbidity of patients who deteriorate slowly.  Care should be taken to recognize certain patients that have elevated MEWS scores due to chronic conditions such as COPD or renal failure. These patients may have a MEWS of 3 or 4 as a baseline number.


The physician and the nurse should collaborate on what would be a significant score for that patient. The trend over time should identify patients that may be at risk.


When do you use the Modified Early Warning Score?


A MEWS score should be calculated for all patients at the beginning of the shift and at any time that the nurse is concerned that there may be a change in condition. Repeated measurements can track the patient's clinical status following interventions such as oxygen therapy or medication administration.Improvement or further deterioration can be flagged.


Several MEWS readings are more informative than one single score as they give a picture of the patient's clinical status over time.


How do you calculate an Early Warning Score?  Click here 


A MEWS is calculated for a patient using six simple physiological parameters:

  • Respiratory rate
  • Heart rate,
  • Systolic blood pressure
  • Temperature
  • Conscious level (AVPU) Alert, responds to Voice, responds to Pain, Unresponsive
  • Urine output

A score is given to a specific range of values for each of the parameters in a table. The patient's data for each parameter is cross referenced against the MEWS table and a score from 0 to 3 is allocated. The score for each parameter is then added to give the MEWS score.


Upcoming Educational Activities

Click here for the December CME Calendar


Visit our CME website:



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Have questions regarding this newsletter? Please contact:

Jann Harrison, RN, MSN, Director of Medical Education

CHRISTUS Santa Rosa Health System