scholarly journals Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out

2019 ◽  
Vol 36 (5) ◽  
pp. 287-292 ◽  
Author(s):  
Lauren J Scott ◽  
Niamh M Redmond ◽  
Joanna Garrett ◽  
Penny Whiting ◽  
Kate Northstone ◽  
...  
Keyword(s):  
Healthcare System ◽  
Early Warning ◽  
Large Scale ◽  
Acute Hospital ◽  
Early Warning Score ◽  
Limited Information ◽  
The West ◽  
Long Term Conditions ◽  
National Early Warning Score ◽  
The Uk

BackgroundEarly warning scores (EWS) were developed in acute hospital settings to improve recognition and response to patient deterioration. In 2012, the UK Royal College of Physicians developed the National Early Warning Score (NEWS) to standardise EWS across the NHS. Its use was also recommended outside acute hospital settings; however, there is limited information about NEWS in these settings. From March 2015, NEWS was implemented across the healthcare system in the West of England, with the aim that NEWS would be calculated for all patients prior to referral into acute care.AimTo describe the distribution and use of NEWS in out-of-hospital settings for patients with acute illness or long-term conditions, following system wide implementation.MethodAnonymised data were obtained from 115 030 emergency department (ED) attendances, 1 137 734 ambulance electronic records, 31 063 community attendances and 15 160 general practitioner (GP) referrals into secondary care, in the West of England. Descriptive statistics are presented.ResultsMost attendance records had NEWS=0–2: 80% in ED, 67% of ambulance attendances and 72% in the community. In contrast, only 8%, 18% and 11% of attendances had NEWS ≥5 (the trigger for escalation of care in-hospital), respectively. Referrals by a GP had higher NEWS on average (46% NEWS=0–2 and 30% NEWS ≥5). By April 2016, the use of NEWS was reasonably stable in ED, ambulance and community populations, and still increasing for GP referrals.ConclusionsNEWS ≥5 occurred in less than 20% of ED, ambulance and community populations studied and 30% of GP referrals. This suggests that in most out-of-hospital settings studied, high scores are reasonably uncommon.

scholarly journals Evaluation and Improvement of the National Early Warning Score (NEWS2) for COVID-19: a multi-hospital study

2020 ◽  
Author(s):  
Ewan Carr ◽  
Rebecca Bendayan ◽  
Daniel Bean ◽  
Matt Stammers ◽  
Wenjuan Wang ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Early Warning ◽  
External Validation ◽  
Early Warning Score ◽  
Minimal Set ◽  
Estimated Gfr ◽  
Risk Stratification Model ◽  
Risk Scoring ◽  
National Early Warning Score ◽  
The Uk

AbstractObjectivesTo evaluate the National Early Warning Score (NEWS2), currently recommended in the UK for risk-stratification of severe COVID-19 outcomes, and subsequently identify and validate a minimal set of common parameters taken at hospital admission that improve the score.DesignRetrospective observational cohort with internal and multi-hospital external validation.SettingSecondary care.InterventionsNot applicable.ParticipantsMain outcome measuresResultsTraining and temporal external validation cohorts comprised 1464 patients admitted to King’s College Hospital NHS Foundation Trust (KCH) with COVID-19 disease from 1st March to 30th April 2020. External validation cohorts included 3869 patients from two UK NHS Trusts (Guys and St Thomas’ Hospitals, GSTT and University Hospitals Southampton, UHS) and two hospitals in Wuhan, China (Wuhan Sixth Hospital and Taikang Tongji Hospital).The primary outcome was patient status at 14 days after symptom onset categorised as severe disease (transferred to intensive care unit or death). Age, physiological measures, blood biomarkers, sex, ethnicity and comorbidities (hypertension, diabetes, cardiovascular, respiratory and kidney diseases) were included.ConclusionsNEWS2 score on admission was a weak predictor of severe COVID-19 infection (AUC = 0.628). Adding age and common blood tests (CRP, neutrophil count, estimated GFR and albumin) provided substantial improvements to a risk stratification model, particularly in relation to sensitivity, but performance was only moderate (AUC = 0.753). Improvement over NEWS2 remained robust and generalisable in GSTT (AUC = 0.817), UHS (AUC = 0.835) and Wuhan hospitals (AUC = 0.918).Adding age and a minimal set of blood parameters to NEWS2 improves the detection of patients likely to develop severe COVID-19 outcomes. This finding was replicated across NHS and non-UK hospitals. Adding a few common parameters to a pre-existing acuity score allows rapid and easy implementation of this risk-scoring system.Key MessagesThe National Early Warning Score (NEWS2), currently recommended for severe COVID-19 disease in the UK shows overall poor discrimination for severe outcomes (transfer to ICU or death). It can be improved by the addition of a small number of blood and physiological parameters routinely measured at hospital admission.The addition of age and a minimal set of common blood tests (C-reactive protein, neutrophil count, estimated GFR and albumin) provided substantial improvements in a risk stratification model.Although predictive performance varied from hospital to hospital, the improvement over NEWS2 alone was consistent across different patient cohorts.The proposed addition of a limited number of dichotomised parameters is easily derived from a pre-existing acuity score would be substantially easier to implement in a short-time scale compared to novel high-dimensional risk-scoring systems.

scholarly journals Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022528 ◽  
Author(s):  
Emer Brangan ◽  
Jonathan Banks ◽  
Heather Brant ◽  
Anne Pullyblank ◽  
Hein Le Roux ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Early Warning ◽  
Acute Hospital ◽  
Early Warning Score ◽  
Healthcare Staff ◽  
The West ◽  
Referral Management ◽  
Acute Hospitals ◽  
Staff Experiences

ObjectivesEarly warning scores were developed to improve recognition of clinical deterioration in acute hospital settings. In England, the National Early Warning Score (NEWS) is increasingly being recommended at a national level for use outside such settings. In 2015, the West of England Academic Health Science Network supported the roll-out of NEWS across a range of non-acute-hospital healthcare sectors. Research on the use of NEWS outside acute hospitals is limited. The objective of this study was to explore staff experiences of using NEWS in these new settings.DesignThematic analysis of qualitative semi-structured interviews with purposefully sampled healthcare staff.SettingWest of England healthcare settings where NEWS was being used outside acute hospitals—primary care, ambulance, referral management, community and mental health services.ParticipantsTwenty-five healthcare staff interviewed from primary care (9), ambulance (3), referral management/acute interface (5), community (4) and mental health services (3), and service commissioning (1).ResultsParticipants reported that NEWS could support clinical decision-making around escalation of care, and provide a clear means of communicating clinical acuity between clinicians and across different healthcare organisations. Challenges with implementing NEWS varied—in primary care, clinicians had to select patients for NEWS and adopt different methods of clinical assessment, whereas for paramedics it fitted well with usual clinical practice and was used for all patients. In community services and mental health, modifications were ‘needed’ to make the tool relevant to some patient populations.ConclusionsThis study demonstrated that while NEWS can work for staff outside acute hospital settings, the potential for routine clinical practice to accommodate NEWS in such settings varied. A tailored approach to implementation in different settings, incorporating guidance supported by further research on the use of NEWS with specific patient groups in community settings, may be beneficial, and enhance staff confidence in the tool.

scholarly journals Implementation of the National Early Warning Score in patients with suspicion of sepsis: evaluation of a system-wide quality improvement project

2020 ◽  
Vol 70 (695) ◽  
pp. e381-e388 ◽  
Author(s):  
Anne Pullyblank ◽  
Alison Tavaré ◽  
Hannah Little ◽  
Emma Redfern ◽  
Hein le Roux ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Early Warning ◽  
Secondary Care ◽  
Hospital Care ◽  
Health Science ◽  
Quality Improvement Project ◽  
Early Warning Score ◽  
The West ◽  
Improvement Project ◽  
National Early Warning Score

BackgroundThe National Early Warning Score (NEWS) was introduced to standardise early warning scores (EWS) in England. It has been recommended that NEWS should be used in pre-hospital care but there is no published evidence that this improves outcomes. In 2015, the West of England Academic Health Science Network region standardised to NEWS across all healthcare settings. Calculation of NEWS was recommended for acutely unwell patients at referral into secondary care.AimTo evaluate whether implementation of NEWS across a healthcare system affects outcomes, specifically addressing the effect on mortality in patients with suspicion of sepsis (SOS).Design and settingA quality improvement project undertaken across the West of England from March 2015 to March 2019, with the aim of standardising to NEWS in secondary care and introducing NEWS into community and primary care.MethodData from the national dashboard for SOS for the West of England were examined over time and compared to the rest of England. Quality improvement methodology and statistical process control charts were used to measure improvement.ResultsThere was a reduction in mortality in the SOS cohort in the West of England, which was not seen in the rest of England over the time period of the project. Admissions did not increase. By March 2019, the West of England had the lowest mortality in the SOS cohort in England.ConclusionTo the authors’ knowledge, this is the first study demonstrating that use of NEWS in pre-hospital care is associated with improved outcomes in patients with SOS.

Use of the National Early Warning Score in community nursing: a scoping review

2021 ◽  
Vol 26 (8) ◽  
pp. 396-404
Author(s):  
Anne-Marie Phillips
Keyword(s):  
Scoping Review ◽  
Early Warning ◽  
Early Warning Score ◽  
Current Evidence ◽  
Community Nursing ◽  
Community Settings ◽  
National Early Warning Score ◽  
Barriers To Use ◽  
Poor Outcomes ◽  
The Uk

People in the UK are living longer and with multi-morbidities, increasing the size, complexity and acuity of Community Nursing caseloads. Nurses visiting infrequently and inconsistently on a task-focused basis need an objective method by which to identify / quantify physical deterioration for early treatment avoiding crisis and hospital admission. The National Early Warning Score (NEWS), is the most recognised tool for identification of deterioration in acute settings but is not validated for community use. Using published frameworks for scoping review and evaluation, this study aims to explore the current evidence for use of NEWS in community settings. Although there is work to be done, particularly in terms of frequency of scoring and response, this study identifies benefits in communication and prioritisation of care as well as sensitivity, particularly in predicting poor outcomes. The identified barriers to use include integration into practice and perceived dissonance with clinical judgement.

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 Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043721
Author(s):  
Donald Richardson ◽  
Muhammad Faisal ◽  
Massimo Fiori ◽  
Kevin Beatson ◽  
Mohammed Mohammed
Keyword(s):  
Hospital Mortality ◽  
Early Warning ◽  
Absolute Risk ◽  
Cross Sectional Study ◽  
Early Warning Score ◽  
Cross Sectional ◽  
Risk Of Mortality ◽  
Baseline Mortality ◽  
Acute Hospitals ◽  
National Early Warning Score

ObjectivesAlthough the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic.DesignA retrospective cross-sectional study.SettingTwo acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.ParticipantsAdult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions.ResultsOut of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%).ConclusionsThe index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19.

scholarly journals National Early Warning Score 2 (NEWS2) better predicts critical Coronavirus Disease 2019 (COVID-19) illness than COVID-GRAM, a multi-centre study

Infection ◽  
2021 ◽  
Author(s):  
Giuseppe Vittorio De Socio ◽  
Anna Gidari ◽  
Francesco Sicari ◽  
Michele Palumbo ◽  
Daniela Francisci
Keyword(s):  
Early Warning ◽  
Operating Characteristic ◽  
Primary Outcome ◽  
Characteristic Curve ◽  
Early Warning Score ◽  
Multi Centre Study ◽  
Umbria Region ◽  
Chinese Cohort ◽  
National Early Warning Score ◽  
Specific Score

Abstract Purpose Clinical scores to rapidly assess the severity illness of Coronavirus Disease 2019 (COVID-19) could be considered of help for clinicians. Recently, a specific score (named COVID-GRAM) for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection, based on a nationwide Chinese cohort, has been proposed. We routinely applied the National Early Warning Score 2 (NEWS2) to predict critical COVID-19. Aim of this study is to compare NEWS2 and COVID-GRAM score. Methods We retrospectively analysed data of 121 COVID-19 patients admitted in two Clinics of Infectious Diseases in the Umbria region, Italy. The primary outcome was critical COVID-19 illness defined as admission to the intensive care unit, invasive ventilation, or death. Accuracy of the scores was evaluated with the area under the receiver-operating characteristic curve (AUROC). Differences between scores were confirmed used Hanley–McNeil test. Results The NEWS2 AUROC curve measured 0.87 (standard error, SE 0.03; 95% CI 0.80–0.93; p < 0.0001). The COVID-GRAM score AUROC curve measured 0.77 (SE 0.04; 95% CI 0.68–0.85; p < 0.0001). Hanley–McNeil test showed that NEWS2 better predicted severe COVID-19 (Z = 2.03). Conclusions The NEWS2 showed superior accuracy to COVID-GRAM score for prediction of critical COVID-19 illness.

Glucose as an additional parameter to National Early Warning Score (NEWS) in prehospital setting enhances identification of patients at risk of death: an observational cohort study

2020 ◽  
pp. emermed-2018-208309
Author(s):  
Hanna Vihonen ◽  
Mitja Lääperi ◽  
Markku Kuisma ◽  
Jussi Pirneskoski ◽  
Jouni Nurmi
Keyword(s):  
At Risk ◽  
Blood Glucose ◽  
Regression Model ◽  
Early Warning ◽  
Prehospital Setting ◽  
Early Warning Score ◽  
Calibration Model ◽  
Risk Of Death ◽  
Patients At Risk ◽  
National Early Warning Score

BackgroundTo determine if prehospital blood glucose could be added to National Early Warning Score (NEWS) for improved identification of risk of short-term mortality.MethodsRetrospective observational study (2008–2015) of adult patients seen by emergency medical services in Helsinki metropolitan area for whom all variables for calculation of NEWS and a blood glucose value were available. Survival of 24 hours and 30 days were determined. The NEWS parameters and glucose were tested by multivariate logistic regression model. Based on ORs we formed NEWSgluc model with hypoglycaemia (≤3.0 mmol/L) 3, normoglycaemia 0 and hyperglycaemia (≥11.1 mmol/L) 1 points. The scores from NEWS and NEWSgluc were compared using discrimination (area under the curve), calibration (Hosmer-Lemeshow test), likelihood ratio tests and reclassification (continuous net reclassification index (cNRI)).ResultsData of 27 141 patients were included in the study. Multivariable regression model for NEWSgluc parameters revealed a strong association with glucose disturbances and 24-hour and 30-day mortality. Likelihood ratios (LRs) for mortality at 24 hours using a cut-off point of 15 were for NEWSgluc: LR+ 17.78 and LR− 0.96 and for NEWS: LR+ 13.50 and LR− 0.92. Results were similar at 30 days. Risks per score point estimation and calibration model showed glucose added benefit to NEWS at 24 hours and at 30 days. Although areas under the curve were similar, reclassification test (cNRI) showed overall improvement of classification of survivors and non-survivors at 24 days and 30 days with NEWSgluc.ConclusionsIncluding glucose in NEWS in the prehospital setting seems to improve identification of patients at risk of death.

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