scholarly journals National Early Warning Scores and COVID-19 deaths in care homes: an ecological time-series study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e045579
Author(s):  
Daniel Stow ◽  
Robert O Barker ◽  
Fiona E Matthews ◽  
Barbara Hanratty
Keyword(s):  
Time Series ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Early Warning ◽  
Cross Correlation ◽  
Local Authority ◽  
Care Home ◽  
Outcome Data ◽  
Care Homes ◽  
Early Warning Scores

ObjectivesTo investigate whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes.Setting460 care home units using the same software package to collect data on residents, from 46 local authority areas in England.Participants6464 care home residents with at least one NEWS recording.Exposure measure29 656 anonymised person-level NEWS from 29 December 2019 to 20 May 2020 with component physiological measures: systolic blood pressure, respiratory rate, pulse rate, temperature and oxygen saturation. Baseline values for each measure calculated using 80th and 20th centile scores before March 2020.Outcome measureCross-correlation comparison of time series with Office for National Statistics weekly reported registered deaths of care home residents where COVID-19 was the underlying cause of death, and all other deaths (excluding COVID-19) up to 10 May 2020.ResultsDeaths due to COVID-19 were registered from 23 March 2020 in the local authority areas represented in the study. Between 23 March 2020 and 10 May 2020, there were 5753 deaths (1532 involving COVID-19 and 4221 other causes). We observed a rise in the proportion of above-baseline NEWS beginning 16 March 2020, followed 2 weeks later by an increase in registered deaths (cross-correlation of r=0.82, p<0.05 for a 2 week lag) in corresponding local authorities. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately 2 weeks before peaks in deaths.ConclusionsNEWS could contribute to COVID-19 disease surveillance in care homes during the pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

scholarly journals National Early Warning Scores And COVID-19 Deaths In Care Homes: An Ecological Time Series Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 962-963
Author(s):  
Daniel Stow ◽  
Robert Barker ◽  
Fiona Matthews ◽  
Barbara Hanratty
Keyword(s):  
Time Series ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Early Warning ◽  
Disease Surveillance ◽  
Care Home ◽  
Outcome Data ◽  
Care Homes ◽  
Individual Level ◽  
Early Warning Scores

Abstract Tracking COVID-19 infections in the care home population has been challenging, because of the limited availability of testing and varied disease presentation. We consider whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes. We analysed NEWS measurements from care homes in England (December 2019 to May 2020). We estimated pre-COVID (baseline) levels for NEWS and NEWS components using 80th and 20th centile scores for measurements before March 2020. We used time-series to compare the proportion of above-baseline NEWS to area-matched reports of registered deaths in care home residents from the Office for National Statistics We analysed 29,656 anonymised NEWS from 6,464 people in 480 care home units across 46 local authority areas. From March 23rd to May 20th, there were 5,753 deaths (1,532 involving COVID-19, 4,221 other causes) in corresponding geographical areas. A rise in the proportion of above-baseline NEWS was observed from March 16th 2020. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in deaths. We conclude that NEWS could contribute to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as total NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

scholarly journals National Early Warning Scores and COVID-19 deaths in care homes: a longitudinal ecological study

2020 ◽  
Author(s):  
Daniel Stow ◽  
Robert O Barker ◽  
Fiona E Matthews ◽  
Barbara Hanratty
Keyword(s):  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Early Warning ◽  
Disease Surveillance ◽  
Ecological Study ◽  
Care Home ◽  
Outcome Data ◽  
Care Homes ◽  
Individual Level ◽  
Early Warning Scores

AbstractObjectivesTo investigate whether patterns of National Early Warning Scores (NEWS/NEWS2) in care homes during the COVID pandemic correspond with area-level COVID-19 death registrations from care homes.Study designLongitudinal ecological study.Setting460 Care home units using the same software package to collect data on residents, from 46 local authority areas in England.Participants6,464 care home residents with at least one NEWS recording.Exposure measure29,656 anonymised person-level NEWS from 29/12/2019 to 20/05/2020 with component physiological measures: systolic blood pressure, respiratory rate, pulse rate, temperature, and oxygen saturation. Baseline values for each measure calculated using 80th and 20th centile scores before March 2020.Outcome measureTime series comparison with Office for National Statistics (ONS) weekly reported registered deaths of care home residents where COVID-19 was the underlying cause of death, and all other deaths (excluding COVID-19) up to 10/05/2020.ResultsDeaths due to COVID-19 were registered from 23/03/2020 in the study geographical areas. Between 23/03/2020 and 10/05/2020, there were 5,753 deaths (1,532 involving COVID-19 and 4,221 other causes). The proportion of above-baseline NEWS increased from 16/03/2020 and closely followed the rise and fall in COVID-19 deaths over the study period. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in care home deaths in corresponding geographical areas.ConclusionsNEWS may make a useful contribution to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as total NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

scholarly journals Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045469
Author(s):  
Rachel Stocker ◽  
Siân Russell ◽  
Jennifer Liddle ◽  
Robert O Barker ◽  
Adam Remmer ◽  
...  
Keyword(s):  
Early Warning ◽  
Healthcare Professionals ◽  
Care Home ◽  
Qualitative Interview ◽  
Interview Study ◽  
Care Homes ◽  
Early Warning Score ◽  
Service Utilisation ◽  
Qualitative Interview Study ◽  
National Early Warning Score

BackgroundThe COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016. Implementation of a NEWS intervention (including equipment, training and support) was accelerated early in the pandemic, despite limited evidence for its use in the care home setting.ObjectivesTo understand how a NEWS intervention has been used in care homes in one area of North-East England during the COVID-19 pandemic, and how it has influenced resident care, from the perspective of stakeholders involved in care delivery and commissioning.MethodsA qualitative interview study with care home (n=10) and National Health Service (n=7) staff. Data were analysed using thematic analysis.ResultsUse of the NEWS intervention in care homes in this area accelerated during the COVID-19 pandemic. Stakeholders felt that NEWS, and its associated education and support package, improved the response of care homes and healthcare professionals to deterioration in residents’ health during the pandemic. Healthcare professionals valued the ability to remotely monitor resident observations, which facilitated triage and treatment decisions. Care home staff felt empowered by NEWS, providing a common clinical language to communicate concerns with external services, acting as an adjunct to staff intuition of resident deterioration.ConclusionsThe NEWS intervention formed an important part of the care home response to COVID-19 in the study area. Positive staff perceptions now need to be supplemented with data on the impact on resident health and well-being, workload, and service utilisation, during the pandemic and beyond.

scholarly journals Protocol for the process evaluation of a cluster randomised controlled trial to determine the effectiveness and cost-effectiveness of independent pharmacist prescribing in care home: the CHIPPS study

2020 ◽  
Author(s):  
Christine Bond ◽  
Richard Holland ◽  
David Alldred ◽  
Antony Arthur ◽  
Garry Baton ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Care Home ◽  
Cluster Randomised Controlled Trial ◽  
Outcome Data ◽  
Care Homes ◽  
Main Trial ◽  
Independent Prescribing ◽  
Gp Care

Abstract Background: Prescribing, monitoring and administration of medicines in care homes could be improved. A cluster RCT is ongoing to evaluate the effectiveness of an independent prescribing pharmacist assuming responsibility for medicines management in care homes compared to usual care. Aims and Objectives: To conduct a mixed methods process evaluation of the RCT, in line with MRC process evaluation guidance, to inform interpretation of main trial findings and if the service is found to be effective and efficient, to inform subsequent implementation. Objectives:1. To describe the intervention as delivered in terms of quality, quantity, adaptations and variations across triads and time. 2. To explore the effects of individual intervention components on the primary outcomes.3. To investigate the mechanisms of action. 4. To describe the perceived effectiveness of relevant intervention components (including PIP training and care home staff training) from participant (GP, care home, PIP and resident/relative) perspectives.5. To describe the characteristics of GP, care home, PIP and resident participants to assess reach.6. To estimate the extent to which intervention delivery is normalised among the intervention healthcare professionals and related practice staff.Methods: A mix of quantitative (surveys, record reviews) and qualitative (interviews) approaches will be used to collect data on the extent of the delivery of detailed tasks required to implement the new service, to collect data to confirm the mechanism of action as hypothesised in the logic model, to collect explanatory process and final outcome data, and data on contextual factors which could have facilitated or hindered effective and efficient delivery of the service. Discussion: Recruitment is ongoing and the trial should complete in early 2020. The systematic and comprehensive approach that is being adopted will ensure data is captured on all aspects of the study, and allow a full understanding of the implementation of the service and the RCT findings. With so many interrelated factors involved it is important that a process evaluation is undertaken to enable us to identify which elements of the service were deemed to be effective, explain any differences seen, and identify enablers, barriers and future adaptions. Trial Registration ISRCTN 17847169 Date registered: 15/12/2017Link: http://www.isrctn.com/ISRCTN17847169

scholarly journals Implementation of the National Early Warning Score in UK care homes: a qualitative evaluation

2020 ◽  
Vol 70 (700) ◽  
pp. e793-e800
Author(s):  
Siân Russell ◽  
Rachel Stocker ◽  
Robert Oliver Barker ◽  
Jennifer Liddle ◽  
Joy Adamson ◽  
...  
Keyword(s):  
Early Warning ◽  
Care Home ◽  
Qualitative Evaluation ◽  
Acute Illness ◽  
Care Homes ◽  
Early Warning Score ◽  
Normalisation Process Theory ◽  
Home Setting ◽  
Care Home Staff ◽  
National Early Warning Score

BackgroundThe National Early Warning Score (NEWS) is a tool for identifying and responding to acute illness. When used in care homes, staff measure residents’ vital signs and record them on a tablet computer, which calculates a NEWS to share with health services. This article outlines an evaluation of NEWS implementation in care homes across one clinical commissioning group area in northern England.AimTo identify challenges to implementation of NEWS in care homes.Design and settingQualitative analysis of interviews conducted with 15 staff members from six care homes, five health professionals, and one clinical commissioning group employee.MethodInterviews were intended to capture people’s attitudes and experiences of using the intervention. Following an inductive thematic analysis, data were considered deductively against normalisation process theory constructs to identify the challenges and successes of implementing NEWS in care homes.ResultsCare home staff and other stakeholders acknowledged that NEWS could enhance the response to acute illness, improve communication with the NHS, and increase the confidence of care home staff. However, the implementation did not account for the complexity of either the intervention or the care home setting. Challenges to engagement included competing priorities, insufficient training, and shortcomings in communication.ConclusionThis evaluation highlights the need to involve care home staff and the primary care services that support them when developing and implementing interventions in care homes. The appropriateness and value of NEWS in non-acute settings requires ongoing monitoring.

Early warning- and track and trigger systems for newborn infants

2017 ◽  
Vol 21 (1) ◽  
pp. 112-120 ◽  
Author(s):  
Nicolay Mortensen ◽  
Johan Henrik Augustsson ◽  
Jorunn Ulriksen ◽  
Unni Tveit Hinna ◽  
Georg M Schmölzer ◽  
...  
Keyword(s):  
Heart Rate ◽  
Intensive Care ◽  
Respiratory Rate ◽  
Intensive Care Units ◽  
Early Warning ◽  
Neonatal Intensive Care ◽  
Newborn Infants ◽  
Scoring Systems ◽  
Neonatal Intensive Care Units ◽  
Early Warning Scores

Tools for clinical assessment and escalation of observation and treatment are insufficiently established in the newborn population. We aimed to provide an overview over early warning- and track and trigger systems for newborn infants and performed a nonsystematic review based on a search in Medline and Cinahl until November 2015. Search terms included ‘infant, newborn’, ‘early warning score’, and ‘track and trigger’. Experts in the field were contacted for identification of unpublished systems. Outcome measures included reference values for physiological parameters including respiratory rate and heart rate, and ways of quantifying the extent of deviations from the reference. Only four neonatal early warning scores were published in full detail, and one system for infants with cardiac disease was considered as having a more general applicability. Temperature, respiratory rate, heart rate, SpO2, capillary refill time, and level of consciousness were parameters commonly included, but the definition and quantification of ‘abnormal’ varied slightly. The available scoring systems were designed for term and near-term infants in postpartum wards, not neonatal intensive care units. In conclusion, there is a limited availability of neonatal early warning scores. Scoring systems for high-risk neonates in neonatal intensive care units and preterm infants were not identified.

scholarly journals Care home services at the vanguard: a qualitative study exploring stakeholder views on the development and evaluation of novel, integrated approaches to enhancing healthcare in care homes

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e017419 ◽  
Author(s):  
Rachel Stocker ◽  
Claire Bamford ◽  
Katie Brittain ◽  
Rachel Duncan ◽  
Suzanne Moffatt ◽  
...  
Keyword(s):  
Health Service ◽  
Qualitative Study ◽  
Local Authority ◽  
Service Providers ◽  
Quality Care ◽  
Care Home ◽  
Third Sector ◽  
Care Homes ◽  
Integrated Approaches ◽  
The Right

ObjectivesTo explore stakeholders’ understanding of novel integrated approaches to enhancing care in care homes (a care home ‘vanguard’) and identify priorities for evaluation.DesignA qualitative study, using semistructured interviews with commissioners and service providers to/within care homes, and third sector organisations with thematic analysis.SettingA Clinical Commissioning Group (CCG) area in England.ParticipantsThirty interviewees from care homes, the National Health Service (NHS; England) and local authority, third sector (10 care home managers, 5 general practitioners, 4 CCG employees, 4 local authority employees, 1 national (NHS England) vanguard lead, 2 specialist nurses, 2 geriatricians, 1 third sector and 1 health manager).ResultsFour higher level themes emerged from the data: understanding of proposed changes, communication, evaluation of outcome measures of success, and trust and complexity. The vision for the new programme was shared by stakeholders, with importance attached to equitable access to high-quality care. Support for the programme was described as being ‘the right thing to do’, inferring a moral imperative. However, the practical implications of key aspects, such as integrated working, were not clearly understood and the programme was perceived by some as being imposed, top down, from the health service. Barriers and facilitators to change were identified across themes of communication, outcomes, trust and complexity. Importance was attached to the measurement of intangible aspects of success, such as collaboration. Interviewees understood that outcome-based commissioning was one element of the new programme, but discussion of their aspirations and practices revealed values and beliefs more compatible with a system based on trust.ConclusionsInnovation in service delivery requires organisations to adopt common priorities and share responsibility for success. The vanguard programme is working to ensure health and local authorities have this commitment, but engaging care homes that may feel isolated from the welfare system needs sustained dialogue over the longer term. Evaluation of the programme needs to measure what is important to stakeholders, and not focus too closely on resource consumption.

scholarly journals Current clinical methods of measurement of respiratory rate give imprecise values

2020 ◽  
Vol 6 (3) ◽  
pp. 00023-2020
Author(s):  
Gordon B. Drummond ◽  
Darius Fischer ◽  
D.K. Arvind
Keyword(s):  
Respiratory Rate ◽  
Early Warning ◽  
Interquartile Range ◽  
Early Warning Score ◽  
Sample Duration ◽  
Single Measure ◽  
Clinical Methods ◽  
Early Warning Scores ◽  
The Mean ◽  
The Uk

BackgroundRespiratory rate is a basic clinical measurement used for illness assessment. Errors in measuring respiratory rate are attributed to observer and equipment problems. Previous studies commonly report rate differences ranging from 2 to 6 breaths·min−1 between observers.MethodsTo study why repeated observations should vary so much, we conducted a virtual experiment, using continuous recordings of breathing from acutely ill patients. These records allowed each breathing cycle to be precisely timed. We made repeated random measures of respiratory rate using different sample durations of 30, 60 and 120 s. We express the variation in these repeated rate measurements for the different sample durations as the interquartile range of the values obtained for each subject. We predicted what values would be found if a single measure, taken from any patient, were repeated and inspected boundary values of 12, 20 or 25 breaths·min−1, used by the UK National Early Warning Score, for possible mis-scoring.ResultsWhen the sample duration was nominally 30 s, the mean interquartile range of repeated estimates was 3.4 breaths·min−1. For the 60 s samples, the mean interquartile range was 3 breaths·min−1, and for the 120 s samples it was 2.5 breaths·min−1. Thus, repeat clinical counts of respiratory rate often differ by >3 breaths·min−1. For 30 s samples, up to 40% of National Early Warning Scores could be misclassified.ConclusionsEarly warning scores will be unreliable when short sample durations are used to measure respiratory rate. Precision improves with longer sample duration, but this may be impractical unless better measurement methods are used.

Determination of the best early warning scores to predict clinical outcomes of patients in emergency department

2019 ◽  
pp. emermed-2019-208622 ◽  
Author(s):  
William Spencer ◽  
Jesse Smith ◽  
Patrick Date ◽  
Erik de Tonnerre ◽  
David McDonald Taylor
Keyword(s):  
Emergency Department ◽  
Clinical Outcomes ◽  
Early Warning ◽  
Predictive Ability ◽  
Outcome Data ◽  
Clinical Deterioration ◽  
Inhospital Mortality ◽  
Icu Admission ◽  
Significant Difference ◽  
Early Warning Scores

ObjectiveEarly warning scores (EWS) are used to predict patient outcomes. We aimed to determine which of 13 EWS, based largely on emergency department (ED) vital sign data, best predict important clinical outcomes.MethodWe undertook a prospective cohort study in a metropolitan, tertiary-referral ED in Melbourne, Australia (February–April 2018). Patient demographics, vital signs and management data were collected while the patients were in the ED and EWS were calculated using each EWS criteria. Outcome data were extracted from the medical record (2-day, 7-day and 28-day inhospital mortality, clinical deterioration within 2 days, intensive care unit (ICU) admission within 2 days, admission to hospital). Area under the receiver operator characteristic (AUROC; 95% CIs) curves were used to evaluate the predictive ability of each EWS for each outcome.ResultsOf 1730 patients enrolled, 690 patients were admitted to the study hospital. Most EWS were good or excellent predictors of 2-day mortality. When considering the point estimates, the VitalPac EWS was the most strongly predictive (AUROC: 0.96; 95% CI: 0.92 to 0.99). However, when considering the 95% CIs, there was no significant difference between the highest performing EWS. The predictive ability for 7-day and 28-day mortality was generally less. No EWS was a good predictor for clinical deterioration (AUROC range: 0.54–0.70), ICU admission (range: 0.51–0.72) or admission to hospital (range: 0.51–0.68).ConclusionSeveral EWS have excellent predictive ability for 2-day mortality and have the potential to risk stratify patients in ED. No EWS adequately predicted clinical deterioration, admission to either ICU or the hospital.

scholarly journals National early warning scores in care homes: do policy imperatives reflect a genuine need?

2019 ◽  
Vol 49 (1) ◽  
pp. 5-6 ◽  
Author(s):  
Sevim Hodge ◽  
Carl Thompson ◽  
Adam L Gordon
Keyword(s):  
Early Warning ◽  
Care Homes ◽  
Early Warning Scores
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