Recording National Early Warning Scores (NEWS) when a patient is urgently referred to hospital can improve the process of care for the sickest patients and reduce the time taken to get to hospital, according to a West of England AHSN supported study funded by National Institute for Health Research (NIHR) at the University of Bristol which has been published in the British Journal of General Practice (BJGP) today [7 April].
National Early Warning Scores help clinicians recognise when patients are at risk of deterioration, for example as a result of infection such as sepsis.
The research team, which included our Primary Care Lead Alison Tavaré, Medical Director Anne Pullyblank and Patient Safety Improvement Lead Hannah Little, was undertaken in collaboration with the NIHR Applied Research Collaboration (ARC) West. The team studied the impact of NEWS scores collected for more than 13,000 urgent GP referrals to hospital. They found that higher scores are associated with patients being taken to hospital by ambulance more quickly. Average transfer time was 94 minutes for patients with the highest scores, compared with 132 minutes for those with the lowest. Patients with high scores were also reviewed more quickly after arriving at hospital.
Patients with higher scores were sicker, with longer hospital stays and more of them being admitted to intensive care. Patients with the highest scores were nearly five times more likely to have sepsis than those with the lowest scores and eight times more likely to die within two days of hospital admission.
Early warning scores (EWS) are designed to help healthcare staff identify patients whose condition is deteriorating, to allow them to get the treatment they need quickly. Higher scores indicate poorer health.
The National Early Warning Score is a simple scoring system of six clinical measurements which are added together to give an overall score, with various thresholds triggering different clinical responses.
National Early Warning Scores are already used in hospitals across England and by ambulance call handlers and paramedics for triage. However, they aren’t consistently used outside hospital and ambulance services, for example in GP surgeries and community settings.
These findings come at a time when the Royal College of General Practitioners (RCGP) is endorsing the use of NEWS in GP surgeries as part of a system-wide response to the COVID-19 pandemic, with new guidance for GPs issued last week in their COVID-19 resource hub.
The researchers also suggest that patients and carers could benefit from education about NEWS to enable the sickest patients to be transferred to hospital quickly.
Dr Alison Tavaré, GP and our Primary Care Clinical Lead, said:
“As a GP I use NEWS alongside clinical judgement when arranging admissions to help secondary care colleagues decide where patients should be seen, by whom, and with what urgency. I feel strongly that NEWS also protects me as a clinician; if a patient unexpectedly has a high NEWS it makes me think ‘have I missed something?”
Alison Tavaré has also written a personal account of contracting sepsis in a Viewpoint article in the same edition of the BJGP. Read more.
Lauren Scott, Senior Research Associate at NIHR ARC West, said:
“We believe calculating NEWS at an earlier point in the patient pathway, in GP surgeries for example, could help the sickest patients receive timely care and therefore save lives. Our findings are particularly relevant in the context of the coronavirus pandemic, as some COVID-19 patients develop sepsis as a result of the infection.
“We found that higher NEWS values recorded at referral into hospital were associated with poorer clinical outcomes, which is to be expected as these patients will usually be the most ill. But we also found that higher NEWS scores meant patients conveyed by ambulance were taken to hospital more quickly, and were assessed more quickly when they got there.”
Lauren J Scott, Niamh M Redmond, Alison Tavare, Hannah Little, Seema Srivastava and Anne Pullyblank
Published in the British Journal for General Practice (BJGP), April 2020.
Posted on April 7, 2020
Created for all staff working across commissioning, clinical, hospital and ambulance service settings to support the successful implementation of the NEWS.