The predictive power of the National Early Warning Score (NEWS) 2, as compared to NEWS, among patients assessed by a Rapid response team: A prospective multi-centre trial

Abstract Background The national early warning score (NEWS) enables early detection of in-hospital patient deterioration and timely activation of hospital’s rapid response team (RRT). NEWS was updated in 2017 to include a separate SpO2 scale for those patients with type II respiratory failure (T2RF). In this study we investigated whether NEWS with and without the new SpO2 scale for the T2RF patients is associated with immediate and in-hospital patient outcomes among the patients actually attended by the RRT. Methods We conducted a two-year prospective observational study including all adult RRT patients without limitations of medical treatment (LOMT) in a large Finnish university associated tertiary level hospital. According to the first vital signs measured by the RRT, we calculated NEWSs for the RRT patients and further utilized the new SpO2 scale for the patients with confirmed T2RF. We used multivariate logistic regression and area under the receiver operating characteristic analyses to test NEWS’s accuracy to predict two distinct outcomes: RRT patient’s I) immediate need for intensive care and/or new LOMT and 2) in-hospital death or discharge with cerebral performance category >2 and/or LOMT. Results The final cohort consisted of 886 RRT patients attended for the first time during their hospitalization. Most common reasons for RRT activation were respiratory (343, 39%) and circulatory (226, 26%) problems. Cohort’s median (Q1, Q3) NEWS at RRT arrival was 8 (5, 10) and remained unchanged if the new SpO2 scale was applied for the 104 patients with confirmed T2RF. Higher NEWS was independently associated with both immediate (OR 1.28; 95% CI 1.22–1.35) and in-hospital (1.15; 1.10–1.21) adverse outcomes. Further, NEWS had fair discrimination for both the immediate (AUROC 0.73; 0.69–0.77) and in-hospital (0.68; 0.64–0.72) outcomes. Utilizing the new SpO2 scale for the patients with confirmed T2RF did not improve the discrimination capability (0.73; 0.69–0.76 and 0.68; 0.64–0.71) for these outcomes, respectively. Conclusions We found that in patients attended by a RRT, the NEWS predicts patient’s hospital outcome with moderate accuracy. We did not find any improvement using the new SpO2 scale in T2RF patients.

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Prognostic accuracy of the Hamilton Early Warning Score (HEWS) and the National Early Warning Score 2 (NEWS2) among hospitalized patients assessed by a rapid response team

Critical Care ◽

10.1186/s13054-019-2355-3 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 11

Author(s):

Shannon M. Fernando ◽

Alison E. Fox-Robichaud ◽

Bram Rochwerg ◽

Pierre Cardinal ◽

Andrew J. E. Seely ◽

...

Keyword(s):

Early Warning ◽

Rapid Response Team ◽

Hospitalized Patients ◽

Rapid Response ◽

Early Warning Score ◽

Prognostic Accuracy ◽

Response Team ◽

National Early Warning Score

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National Early Warning Score vs Rapid Response Team criteria-Prevalence, misclassification, and outcome

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13245 ◽

2018 ◽

Vol 63 (2) ◽

pp. 215-221 ◽

Cited By ~ 2

Author(s):

Ola Friman ◽

Max Bell ◽

Therese Djärv ◽

Andreas Hvarfner ◽

Gabriella Jäderling

Keyword(s):

Early Warning ◽

Rapid Response Team ◽

Rapid Response ◽

Early Warning Score ◽

Response Team ◽

National Early Warning Score

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Early Warning Score Communication Bundle: A Pilot Study

American Journal of Critical Care ◽

10.4037/ajcc2018513 ◽

2018 ◽

Vol 27 (3) ◽

pp. 238-242

Author(s):

Cheryl Gagne ◽

Susan Fetzer

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Early Warning ◽

Rapid Response Team ◽

Rapid Response ◽

Early Warning Score ◽

Early Warning Scores ◽

Response Team ◽

Intensive Care Unit Nurses ◽

The Impact

Background Unplanned admissions of patients to intensive care units from medical-surgical units often result from failure to recognize clinical deterioration. The early warning score is a clinical decision support tool for nurse surveillance but must be communicated to nurses and implemented appropriately. A communication process including collaboration with experienced intensive care unit nurses may reduce unplanned transfers. Objective To determine the impact of an early warning score communication bundle on medical-surgical transfers to the intensive care unit, rapid response team calls, and morbidity of patients upon intensive care unit transfer. Methods After an early warning score was electronically embedded into medical records, a communication bundle including notification of and telephone collaboration between medical-surgical and intensive care unit nurses was implemented. Data were collected 3 months before and 21 months after implementation. Results Rapid response team calls increased nonsignificantly during the study period (from 6.47 to 8.29 per 1000 patient-days). Rapid response team calls for patients with early warning scores greater than 4 declined (from 2.04 to 1.77 per 1000 patient-days). Intensive care unit admissions of patients after rapid response team calls significantly declined (P = .03), as did admissions of patients with early warning scores greater than 4 (P = .01), suggesting that earlier intervention for patient deterioration occurred. Documented reassessment response time declined significantly to 28 minutes (P = .002). Conclusion Electronic surveillance and collaboration with experienced intensive care unit nurses may improve care, control costs, and save lives. Critical care nurses have a role in coaching and guiding less experienced nurses.

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National early warning score (NEWS) – evaluation in surgery

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-01-2014-0012 ◽

2015 ◽

Vol 28 (3) ◽

pp. 245-252 ◽

Cited By ~ 5

Author(s):

Peter M Neary ◽

Mark Regan ◽

Myles J Joyce ◽

Oliver J McAnena ◽

Ian Callanan

Keyword(s):

Patient Outcome ◽

Improve Patient Care ◽

Rapid Response Team ◽

Rapid Response ◽

Early Warning Score ◽

Content Type ◽

Response Team ◽

National Early Warning Score ◽

The Impact ◽

Improve Patient

Purpose – The purpose of this paper is to evaluate staff opinion on the impact of the National Early Warning Score (NEWS) system on surgical wards. In 2012, the NEWS system was introduced to Irish hospitals on a phased basis as part of a national clinical programme in acute care. Design/methodology/approach – A modified established questionnaire was given to surgical nursing staff, surgical registrars, surgical senior house officers and surgical interns for completion six months following the introduction of the NEWS system into an Irish university hospital. Findings – Amongst the registrars, 89 per cent were unsure if the NEWS system would improve patient care. Less than half of staff felt consultants and surgical registrars supported the NEWS system. Staff felt the NEWS did not correlate well clinically with patients within the first 24 hours (Day zero) post-operatively. Furthermore, 78-85 per cent of nurses and registrars felt a rapid response team should be part of the escalation protocol. Research limitations/implications – Senior medical staff were not convinced that the NEWS system may improve patient care. Appropriate audit proving a beneficial impact of the NEWS system on patient outcome may be essential in gaining support from senior doctors. Deficiencies with the system were also observed including the absence of a rapid response team as part of the escalation protocol and a lack of concordance of the NEWS in patients Day zero post-operatively. These issues should be addressed moving forward. Originality/value – Appropriate audit of the impact of the NEWS system on patient outcome may be pertinent to obtain the support from senior doctors. Deficiencies with the system were also observed including the absence of a rapid response team as part of the escalation protocol and a lack of concordance of the NEWS in patients Day zero post-operatively. These issues should be addressed moving forward.

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Utilization of Electronic Modified Early Warning Score to Engage Rapid Response Team Early in Clinical Deterioration

Journal for Nurses in Professional Development ◽

10.1097/nnd.0000000000000157 ◽

2015 ◽

Vol 31 (3) ◽

pp. E1-E7 ◽

Cited By ~ 2

Author(s):

Melody A. Rose ◽

Lee Ann Hanna ◽

Sareda A. Nur ◽

Constance M. Johnson

Keyword(s):

Early Warning ◽

Rapid Response Team ◽

Rapid Response ◽

Clinical Deterioration ◽

Early Warning Score ◽

Response Team

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Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support

PLoS ONE ◽

10.1371/journal.pone.0259577 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259577

Author(s):

Lorena Micheline Alves Silva ◽

Diego Marques Moroço ◽

José Paulo Pintya ◽

Carlos Henrique Miranda

Keyword(s):

Emergency Department ◽

High Risk ◽

Mortality Rate ◽

Hospital Mortality ◽

Early Warning ◽

Rapid Response Team ◽

Rapid Response ◽

Early Warning Score ◽

Before And After ◽

Response Team

Background Emergency department (ED) crowding is a frequent situation. To decrease this overload, patients without a life-threating condition are transferred to wards that offer ED support. This study aimed to evaluate if implementing a rapid response team (RRT) triggered by the modified early warning score (MEWS) in high-risk wards offering ED support is associated with decreased in-hospital mortality rate. Methods A before-and-after cross-sectional study compared in-hospital mortality rates before and after implementation of an RRT triggered by the MEWS ≥4 in two wards of a tertiary hospital that offer ED support. Results We included 6863 patients hospitalized in these wards before RRT implementation from July 2015 through June 2017 and 6944 patients hospitalized in these same wards after RRT implementation from July 2018 through June 2020. We observed a statistically significant decrease in the in-hospital mortality rate after intervention, 449 deaths/6944 hospitalizations [6.47% (95% confidence interval (CI) 5.91%– 7.07%)] compared to 534 deaths/6863 hospitalizations [7.78% (95% CI 7.17–8.44)] before intervention; with an absolute risk reduction of -1.31% (95% CI -2.20 –-0.50). Conclusion RRT trigged by the MEWS≥4 in high-risk wards that offer ED support was found to be associated with a decreased in-hospital mortality rate. A further cluster-randomized trial should evaluate the impact of this intervention in this setting.

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