MRC-ICU Score vs Local Clinical Monitoring Score: Integration and Comparison at a Tertiary Hospital

Introduction: Objective, quantifiable, and automated metrics of pharmacist workload are useful for both position justification and real-time workload allocation. The Medication Complexity Regimen – Intensive Care Unit (MRC-ICU) clinical score was developed as an objective measure of patient complexity in critically ill patients. The Clinical Monitoring Score (CMS) is an institution specific, non-validated, dynamic scoring system. The purpose of this study was to determine the relationship between the two scores and their relationships on pharmacist workload and patient outcomes in a large, tertiary community hospital.


Methods: This single-center, retrospective evaluation included patients over a three-month period (December 2024 – February 2025) admitted to a 28-bed adult, mixed medical-surgical ICU. The two scores were integrated into in the electronic health record. The primary outcome of this study was the correlation of CMS to MRC-ICU in relation to pharmacist interventions, as measured by Spearman’s Rank Test. Linear and logistic univariate and multivariate regression were also applied to assess relationships to mortality and length of stay.


Results: A total of 299 patients were included. The median MRC-ICU score was 11 (IQR, 8-14), and the median CMS was 2 (IQR, 0.5-3). Multivariate modeling controlling for severity of illness showed that the correlation to pharmacist interventions (i-Vents) remained significant for both MRC-ICU (β coefficient, 1.02; 95% CI, 0.65-1.41; p < 0.001) and CMS (β coefficient, 1.4; 95% CI, 0.97-1.82; p < 0.001); however, only MRC-ICU remained a significant predictor for ICU (β coefficient, 1.02; 95% CI, 0.65-1.41; p < 0.001) and hospital LOS (β coefficient, 1.02; 95% CI, 0.65-1.41; p < 0.001). Additionally, univariate modeling showed a significant correlation between mortality and both MRC-ICU (OR, 1.09; 95% CI, 1.03 – 1.16; p = 0.004) and CMS (OR, 1.11; 95% CI, 1.03 – 1.16; p = 0.004).


Conclusions: This was the first study to compare the MRC-ICU to an institution specific, dynamic scoring system in the adult ICU setting. This study supports future use of automated metrics to capture pharmacist workload.