A good idea badly implemented? Revised National Early Warning Score 2 in community settings

2019 ◽  
Vol 24 (6) ◽  
pp. 291-294
Author(s):  
Linda Nazarko

The revised National Early Warning Score (NEWS2), a tool used to measure acute deterioration in hospital, has been introduced in acute NHS hospitals and ambulance services. Community nurses report that when they call 999 requesting an ambulance to take a person to hospital, they are asked to provide a NEWS score. They report that when the NEWS score is high, ambulance staff prioritise the call. The NEWS score is being introduced in the community by default. This article will outline how the NEWS score is calculated, its uses and limitations and asks if the NEWS score accurately measures acute deterioration in people living in the community and predicts the need for referral to accident and emergency services.

2021 ◽  
Vol 26 (8) ◽  
pp. 396-404
Author(s):  
Anne-Marie Phillips

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.


BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045469
Author(s):  
Rachel Stocker ◽  
Siân Russell ◽  
Jennifer Liddle ◽  
Robert O Barker ◽  
Adam Remmer ◽  
...  

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.


BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e043721
Author(s):  
Donald Richardson ◽  
Muhammad Faisal ◽  
Massimo Fiori ◽  
Kevin Beatson ◽  
Mohammed Mohammed

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.


Infection ◽  
2021 ◽  
Author(s):  
Giuseppe Vittorio De Socio ◽  
Anna Gidari ◽  
Francesco Sicari ◽  
Michele Palumbo ◽  
Daniela Francisci

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.


2020 ◽  
pp. emermed-2018-208309
Author(s):  
Hanna Vihonen ◽  
Mitja Lääperi ◽  
Markku Kuisma ◽  
Jussi Pirneskoski ◽  
Jouni Nurmi

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.


PLoS ONE ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. e0211133 ◽  
Author(s):  
Anniek Brink ◽  
Jelmer Alsma ◽  
Rob Johannes Carel Gerardus Verdonschot ◽  
Pleunie Petronella Marie Rood ◽  
Robert Zietse ◽  
...  

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