scholarly journals Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care

2020 ◽  
Vol 70 (695) ◽  
pp. e374-e380 ◽  
Author(s):  
Lauren J Scott ◽  
Niamh M Redmond ◽  
Alison Tavaré ◽  
Hannah Little ◽  
Seema Srivastava ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Clinical Outcomes ◽  
Early Warning ◽  
Secondary Care ◽  
Early Warning Score ◽  
Medical Review ◽  
News Values ◽  
Process Measures ◽  
Sepsis Diagnosis

BackgroundNHS England has mandated use of the National Early Warning Score (NEWS), more recently NEWS2, in acute settings, and suggested its use in primary care. However, there is reluctance from GPs to adopt NEWS/NEWS2.AimTo assess whether NEWS calculated at the point of GP referral into hospital is associated with outcomes in secondary care.Design and settingAn observational study using routinely collected data from primary and secondary care.MethodNEWS values were prospectively collected for 13 047 GP referrals into acute care between July 2017 and December 2018. NEWS values were examined and multivariate linear and logistic regression used to assess associations with process measures and clinical outcomes.ResultsHigher NEWS values were associated with faster conveyance for patients travelling by ambulance, for example, median 94 minutes (interquartile range [IQR] 69–139) for NEWS ≥7; median 132 minutes, (IQR 84–236) for NEWS = 0 to 2); faster time from hospital arrival to medical review (54 minutes [IQR 25–114] for NEWS ≥7; 78 minutes [IQR 34–158] for NEWS = 0 to 2); as well as increased length of stay (5 days [IQR 2–11] versus 1 day [IQR 0–5]); intensive care unit admissions (2.0% versus 0.5%); sepsis diagnosis (11.7% versus 2.5%); and mortality, for example, 30-day mortality 12.0% versus 4.1% for NEWS ≥7 versus NEWS = 0 to 2, respectively. On average, for patients referred without a NEWS value (NEWS = NR), most clinical outcomes were comparable with patients with NEWS = 3 to 4, but ambulance conveyance time and time to medical review were comparable with patients with NEWS = 0 to 2.ConclusionThis study has demonstrated that higher NEWS values calculated at GP referral into hospital are associated with a faster medical review and poorer clinical outcomes.

scholarly journals Assessment and referral in suspected COVID-19: a community based observational study

2021 ◽  
Author(s):  
Samuel Finnikin ◽  
Shamil Haroon ◽  
Jennifer Cooper ◽  
Astha Anand ◽  
Abijan Pakiyaraja ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Service Delivery ◽  
Clinical Diagnosis ◽  
Secondary Care ◽  
Urgent Care ◽  
Early Warning Score ◽  
Free Text ◽  
Research Database ◽  
Referral Decisions

Abstract Background The COVID-19 pandemic presented new diagnostic and management challenges to primary care alongside rapid changes in service delivery. The purpose of this study was to describe the characteristics of patients with symptoms of COVID-19 in primary care, explore which characteristics were associated with a clinical diagnosis of COVID-19 and referrals to secondary care, and to describe secondary care referral decisions with reference to national guidance. Methods An observational study using routinely collected data from the Birmingham Out-of-hours Research Database. The study uses consultation data from the Birmingham and Solihull COVID Referral Centre (CRC) between 21st April and 24th July. All CRC consultations were examined to extract patient demographics, free text consultations, prescriptions, observation and onward referrals. The National Early Warning Score (NEWS2) was calculated and the clinical diagnosis of COVID-19 was established. The population was described and univariate logistic regression was used to identify characteristics associated with clinical diagnosis of COVID-19 and referral decisions. Results 681 patients were seen at the CRC and 56.3% were identified to have a clinical diagnosis of COVID-19. 14.0% of all patients were referred to secondary care, but 59% of patients classified as most severe according to national criteria were not referred. Referral was associated with increasing age, shortness of breath, tachycardia, tachypnoea and hypoxia but patients with a clinical COVID-19 diagnosis were less likely to be referred than those with other diagnoses. Conclusion Just over half of patients seen in the CRC were clinically diagnosed with COVID-19 and most patients were managed in the community. Guidelines developed in the absence of service delivery data for the management of COVID-19 were inconsistent with community urgent care delivery.

scholarly journals A proposed Primary Health Early Warning Score (PHEWS) with emphasis on early detection of sepsis in the elderly

2016 ◽  
Vol 8 (1) ◽  
pp. 5 ◽  
Author(s):  
Ian Anderson
Keyword(s):  
Primary Care ◽  
Early Detection ◽  
Acute Care ◽  
Early Warning ◽  
Secondary Care ◽  
The Elderly ◽  
Early Warning Score ◽  
Severe Illness ◽  
Primary Health ◽  
Early Warning Scores

ABSTRACT There are several secondary care early warning scores which alert for severe illness including sepsis. None are specifically adjusted for primary care. A Primary Health Early Warning Score (PHEWS) is proposed which incorporates practical parameters from both secondary and primary care. KEYWORDS: Emergency medical services; acute care; sepsis; early intervention

scholarly journals The Value of Modified Early Warning Score (MEWS) in Surgical In-Patients: A Prospective Observational Study

2006 ◽  
Vol 88 (6) ◽  
pp. 571-575 ◽  
Author(s):  
J Gardner-Thorpe ◽  
N Love ◽  
J Wrightson ◽  
S Walsh ◽  
N Keeling
Keyword(s):  
Risk Management ◽  
Observational Study ◽  
Critically Ill ◽  
Early Warning ◽  
Critically Ill Patients ◽  
Prospective Observational Study ◽  
Early Warning Score ◽  
Management Tool ◽  
Quality And Safety ◽  
Surgical Ward

INTRODUCTION The Modified Early Warning Score (MEWS) is a simple, physiological score that may allow improvement in the quality and safety of management provided to surgical ward patients. The primary purpose is to prevent delay in intervention or transfer of critically ill patients. PATIENTS AND METHODS A total of 334 consecutive ward patients were prospectively studied. MEWS were recorded on all patients and the primary end-point was transfer to ITU or HDU. RESULTS Fifty-seven (17%) ward patients triggered the call-out algorithm by scoring four or more on MEWS. Emergency patients were more likely to trigger the system than elective patients. Sixteen (5% of the total) patients were admitted to the ITU or HDU. MEWS with a threshold of four or more was 75% sensitive and 83% specific for patients who required transfer to ITU or HDU. CONCLUSIONS The MEWS in association with a call-out algorithm is a useful and appropriate risk-management tool that should be implemented for all surgical in-patients.

scholarly journals Modified Early Warning Score (MEWS) Identifies Critical Illness among Ward Patients in a Resource Restricted Setting in Kampala, Uganda: A Prospective Observational Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (3) ◽  
pp. e0151408 ◽  
Author(s):  
Rebecca Kruisselbrink ◽  
Arthur Kwizera ◽  
Mark Crowther ◽  
Alison Fox-Robichaud ◽  
Timothy O'Shea ◽  
...  
Keyword(s):  
Critical Illness ◽  
Observational Study ◽  
Early Warning ◽  
Prospective Observational Study ◽  
Early Warning Score

scholarly journals Modified Early Warning Score as a predictor of intensive care unit readmission within 48 hours: a retrospective observational study

2020 ◽  
Vol 32 (2) ◽  
Author(s):  
Ahmed Naji Balshi ◽  
Basim Mohammed Huwait ◽  
Alfateh Sayed Nasr Noor ◽  
Abdulrahman Mishaal Alharthy ◽  
Ahmed Fouad Madi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Early Warning ◽  
Early Warning Score ◽  
Retrospective Observational Study ◽  
Intensive Care Unit Readmission

scholarly journals Financial performance of English NHS trusts and variation in clinical outcomes: a longitudinal observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e021854
Author(s):  
Myura Nagendran ◽  
Grace Kiew ◽  
Rosalind Raine ◽  
Rifat Atun ◽  
Mahiben Maruthappu
Keyword(s):  
Observational Study ◽  
Financial Performance ◽  
Clinical Outcomes ◽  
Waiting Time ◽  
Hospital Readmissions ◽  
Fold Increase ◽  
Satisfaction Score ◽  
Process Measures ◽  
Longitudinal Observational Study ◽  
Operating Margin

ObjectivesTo examine the association between financial performance as measured by operating margin (surplus/deficit as a proportion of turnover) and clinical outcomes in English National Health Service (NHS) trusts.SettingLongitudinal, observational study in 149 acute NHS trusts in England between the financial years 2011 and 2016.ParticipantsOur analysis focused on outcomes at individual NHS Trust-level (composed of one or more acute hospitals).Primary and secondary outcomesOutcome measures included readmissions, inpatient satisfaction score and the following process measures: emergency department (Accident and Emergency (A&E)) waiting time targets, cancer referral and treatment targets and delayed transfers of care (DTOCs).ResultsThere was a progressive increase in the proportion of trusts in financial deficit: 22% in 2011, 27% in 2012, 28% in 2013, 51% in 2014, 68% in 2015 and 91% in 2016. In linear regression analyses, there was no significant association between operating margin and clinical outcomes (readmission rate or inpatient satisfaction score). There was, however, a significant association between operating margin and process measures (DTOCs, A&E breaches and cancer waiting time targets). Between the best and worst financially performing Trusts, there was an approximately 2-fold increase in A&E breaches and DTOCs overall although this variation decreased over the 6 years. Between the best and worst performing trusts on cancer targets, the magnitude of difference was smaller (1.16 and 1.15-fold), although the variation slowly rose during the 6 years.ConclusionsOperating margins in English NHS trusts progressively worsened during 2011–2016, and this change was associated with poorer performance on several process measures but not with hospital readmissions or inpatient satisfaction. Significant variation exists between the best and worst financially performing Trusts. Further research is needed to examine the causal nature of relationships between financial performance, process measures and outcomes.

scholarly journals National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Joonas Tirkkonen ◽  
Sari Karlsson ◽  
Markus B. Skrifvars
Keyword(s):  
Observational Study ◽  
Early Warning ◽  
Prospective Observational Study ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Early Warning Score ◽  
Hospital Death ◽  
Hospital Patient ◽  
Response Team ◽  
National Early Warning Score

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.

scholarly journals Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

2015 ◽  
Vol 21 (4) ◽  
pp. 391 ◽  
Author(s):  
Geoffrey K. Mitchell ◽  
Letitia Burridge ◽  
Jianzhen Zhang ◽  
Maria Donald ◽  
Ian A. Scott ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Service Delivery ◽  
Disease Control ◽  
Usual Care ◽  
Clinical Outcomes ◽  
Secondary Care ◽  
Design Elements ◽  
Primary Care Practitioners ◽  
The Impact

Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary–secondary care. Six elements were identified that were common to these models of integrated primary–secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary–secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness.

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