Posted on January 17, 2022
Prior to use of the National Early Warning Score (NEWS) across healthcare systems there was no standardised response to deterioration or common ‘language’ used at all handovers of care for acutely unwell patients.
The Royal College of Physicians (RCP) developed NEWS and the updated NEWS2 as an aggregate scoring system of physiological observations that act as a ‘track and trigger’ for deterioration, providing a common language across settings.
Supported by the West of England AHSN, NEWS was adopted across all elements of the region’s healthcare system, with the AHSN bringing together healthcare staff to work collaboratively, share ideas, experiences and data around implementation.
The use of NEWS across the West of England demonstrated improved outcomes compared to the rest of the country and NEWS2 was subsequently rolled out nationally through the AHSN Network’s Patient Safety Collaboratives in 2018-20.
NEWS2 continues to be used in all health and community care settings and has been advocated, alongside clinical judgement, as a tool to support monitoring of patients with COVID-19.
Further work around managing patient deterioration in the West of England has evolved from the success of our adoption and spread of NEWS, including the Emergency Department (ED) Safety Checklist and use of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment).
“The Early Warning Score empowered us to explain the necessity for immediate referral to the acute sector. The good news is that thanks to NEWS and the sepsis screening tool, the right response was received at the right place enabling the patient’s life to be saved”.
North Somerset Community Partnership Rapid Response
Prior to the use of NEWS, health care settings did not use the same common language or set of measurements at the handovers of care. This resulted in a lack of consistency in identification and response to acute illness.
NEWS is a simple scoring system, based on the six physiological measurements that make up the routine vital signs of an adult patient. By monitoring scores over time, NEWS can demonstrate a positive response to treatment, or more importantly, allow early detection of patient deterioration. Early recognition and management of deterioration leads to improved outcomes for patients.
In 2015, NEWS was only used in some hospitals in the West of England and was not used at all in pre-hospital care.
In March 2015, the West of England Patient Safety Collaborative became the first region to implement NEWS. In the West of England 26 organisations – including all acute trusts, out-of-hours GP services, mental health trusts, community service providers and three clinical commissioning groups – agreed to support the adoption and spread of NEWS and to communicate the score at handovers of care across the system. The AHSN produced a suite of resources, including a NEWS2 toolkit, to support implementation.
The AHSN used an IHI Breakthrough collaborative model to bring people together every six months, with local task groups meeting more frequently. The AHSN facilitated the introduction of NEWS into the South Western Ambulance Service Foundation Trust’s electronic Patient Care Record and supported implementation and spread.
The AHSN also created Primary Care, ED and Community Collaboratives to enable sectors to meet and share best practice on patient safety including NEWS and the ED Safety Checklist . Work was also undertaken with the sepsis cluster. In addition, band 4 healthcare providers in the community were trained on human factors and SBAR communication.
During the pandemic, and in line with the British Geriatrics Society paper offering key recommendations to help care home staff support residents through the pandemic, the West of England AHSN has been focusing on training care home staff in the use of NEWS2 as part of RESTORE2 training. Free training on RESTORE2 mini is also provided for residential and domiciliary care workers to spot, and act on, the soft signs of deterioration.
Impact to date
To illustrate where NEWS has improved patient outcomes by use of consistent assessment and triggering of responses across patient pathways a number of patient stories have been collated from across the region. The stories include a patient in North Somerset, who made a quick and full recovery from sepsis as a result of his NEWS being communicated at every handover of care.
From 2018 to 2020, NEWS2 was rolled out nationally through the AHSN Network’s Patient Safety programme, commissioned by NHS Improvement. Prior to the programme’s selection for national adoption and spread the West of England AHSN produced an explainer video to showcase use of NEWS.
In collaboration with ARC West, a systematic review demonstrated that there was no published study where NEWS had been implemented across a healthcare system but that early warning scores were good at predicting short term outcome .
A qualitative study demonstrated that NEWS was useful as an adjunct to decision making .
The AHSN demonstrated distribution of NEWS across pre-hospital settings and showed that a NEWS of 5 was a reasonable trigger for escalation in pre-hospital care  and that by using a system approach, patients with higher NEWS reached hospital quicker and were seen more quickly.
The AHSN also demonstrated that NEWS could predict outcomes in patients seen in non-hospital settings and that our system approach led to the West of England having the lowest mortality in England in patients with suspicion of sepsis .
The National Confidential Enquiry into Patient Outcome and Death report argued that NEWS has increasingly become part of the lexicon for communication about physiology between all health care providers, enhancing and focusing the handover of technical information about patients, especially those at risk of deterioration.
In 2020, the AHSN and NIHR ARC West examined the impact of COVID-19 on NEWS2 across four acute hospital trusts in the West of England region. The study concluded using NEWS2 can help identify those COVID-19 patients who are sickest and at risk of dying, a study published in Emergency Medicine Journal has shown.
While this West of England AHSN programme has now ended, the ongoing impact of our adoption of NEWS, and related collaboratives, continues to be felt today in the work of the AHSN and our Patient Safety Collaborative, particularly around managing patient deterioration.
For instance, our NEWS roll-out led to the training of thousands of care home staff and carers to detect and communicate the soft signs of deterioration. Free videos, produced by the AHSN and partners, to help staff working in care homes spot and respond to the soft signs of deterioration, have been viewed more than 600,000 times and were shortlisted for a 2021 HSJ Patient Safety Award.
Our West of England Learning Disabilities Collaborative continues to advocate use of NEWS2 and soft-signs tools to support early identification of physical deterioration in patients who may be less able to communicate feeling unwell.
Our programme to support the use of ReSPECT (Recommended Summary Plan for Emergency Care and Treatment), also evolved from insights gained through the ED Collaborative and NEWS project around inappropriate end of life ED attendance and conveyance, alongside our wider work around Structured Mortality Reviews.
The information in this case study is based on the period March 2015-March 2020.
- Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review. Rita Patel, Manjula D. Nugawela, Hannah B. Edwards, Alison Richards, Hein Le Roux, Anne Pullyblank, Penny Whiting. Resuscitation 132 (2018) 101-111
- Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England. Emer Brangan, Jonathan Banks, Heather Brant, Anne Pullyblank, Hein Le Roux, Sabi Redwood. BMJ Open2018;8:e022528. doi:10.1136/bmjopen-2018-022528
- Distribution of the National Early Warning Score (NEWS) across a healthcare system following a large scale roll-out. Lauren J Scott, Niamh M Redmond, Joanna Garrett, Penny Whiting, Kate Northstone, Anne Pullyblank 10.1136/emermed-2018-208140 March 6 2019
- Scott LJ, Redmond NM, Tavare A, et al. Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care. Br J Gen Pract. 2020;70(695):e374-e80.
- Pullyblank, A., Tavaré, A., Little, H., Redfern, E., le Roux, H., Inada-Kim, M., Cheema, K. and Cook, A.on behalf of the West of England Patient Safety Collaborative. Implementation of the National Early Warning Score in patients with suspicion of sepsis: evaluation of a system-wide quality improvement project. British Journal of General Practice 8 April 2020; bjgp20X709349. DOI: https://doi.org/10.3399/bjgp20X709349