Using National Early Warning Scores in pre-hospital settings
17 Oct 2018

Using National Early Warning Scores in pre-hospital settings

Published Date: 17 Oct 2018

The National Early Warning Score (NEWS) was introduced by the Royal College of Physicians in 2012 to identify and respond to patients at risk of clinical deterioration, primarily for use in acute hospital care although its potential in other settings was highlighted. In 2015 the West of England Academic Health Sciences Network (WEAHSN) supported the use of the tool in all acute hospitals and in a wide range of out-of-hospital settings in the West of England, including primary care, the ambulance service, community care, mental health, and acute referral services. The aim of using NEWS was to have a standardised tool for communication at patient handovers and to facilitate early recognition of acute illness including sepsis. CLAHRC West conducted a mixed-method evaluation including systematic reviews of existing evidence, statistical analysis of the distribution of NEWS scores in four healthcare organisations, and the scores’ relationship with time to treatment and length of stay. Interviews were conducted with staff using NEWS in out-of-hospital settings. The findings demonstrated that NEWS had good predictive accuracy at the lower and higher ends of the scale and that scores above 5 were uncommon even in patients with chronic health conditions. Overall, the evaluation suggested that NEWS has the potential to contribute to improving care of acutely unwell patients. However, some benefits are at least partly contingent on system-wide adoption of the tool, on a clear understanding of when to use NEWS in each clinical setting, and how to apply triggers for action.

Since the system-wide adoption of NEWS which started in 2015, there has been a reduction in mortality for patients who are suspected of having sepsis and the West of England now has the lowest mortality in England for this patient group.

Contribution of CLAHRC West

Working with the WEAHSN as their evaluation partner, crucial evidence was delivered on the predictive accuracy of early warning scores such as NEWS, data sources identified and utilised to demonstrate the effectiveness of using NEWS out-of-hospital, and healthcare staff’s experiences of using NEWS in clinical practice were recorded. During the process of the evaluation, the research team fed back early findings and emergent insights which shaped the implementation strategy and roll-out. Four papers arising from this work have been submitted.

What happened next?

The combination of regional collaboration, adoption of NEWS by all acute trusts and an increasing number of out-of-hospital care settings, adaptation of the ambulance electronic record system and redesign of pathways means patients are assessed, transferred and triaged more effectively and efficiently. Since the system-wide adoption of NEWS which started in 2015, there has been a reduction in mortality for patients who are suspected of having sepsis and the West of England now has the lowest mortality in England for this patient group. The WEAHSN Patient Safety Collaborative has been shortlisted for both 2018 HSJ and BMJ Patient Safety awards for deteriorating patients.