The West of England Patient Safety Collaborative was the first area to implement NEWS2 as a common language across a region. NEWS2 is the latest version of the National Early Warning Score, developed by The Royal College of Physicians (RCP). Find out more about NEWS2 on the RCP website.
Currently, all acute trusts, out-of-hours GP services, mental health trusts, community service providers and clinical commissioning groups (CCGs) have all signed up to support the adoption and spread of NEWS2, and communicating this score at the interfaces of care across the system.
The use of early warning scores is being recommended in primary and community care settings. The National Confidential Enquiry into Patient Outcome and Death report in November 2015 (‘Just Say Sepsis!’) argued that an early warning score should be used in both primary and secondary care wherever sepsis is suspected. Early warning scores are increasingly becoming 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.
View a summary of the NEWS2 project in the form of a PDF poster, including results and challenges.
Read our NEWS case study.
NEWS in practice
We now have a number of examples of patient stories from across the region where NEWS has been used to assess and trigger responses across patient pathways and ultimately improving outcomes for those patients.
One of these examples was a patient in North Somerset who visited his GP with cellulitis but felt very poorly. The GP used NEWS to assess that the patient was acutely unwell and needed rapid treatment. NEWS was used to track the patient’s condition from primary care, into the ambulance and into the Emergency Department and clearly showed he was deteriorating. This patient had sepsis but thanks to the early detection of his condition in primary care, it was treated within five hours of seeing his GP and he made a quick and full recovery.
We have produced a short film which tells this NEWS2 story.
NEWS in acute settings
In order to achieve our aims we adopted a breakthrough collaborative model. The West of England AHSN supported all acute trusts in the region to adopt NEWS, supported by a NEWS Implementation Toolkit. All acute trusts are now using the updated NEWS2, as recommended by the Royal College of Physicians. View our regional NEWS Implementation Toolkit here (PDF).
A free NEWS2 NHS toolkit is available.
NEWS in emergency departments
We supported the national adoption and spread of the Emergency Department (ED) Safety Checklist, piloted at University Hospitals Bristol NHS Foundation Trust. The checklist includes the requirement to take hourly observations and calculate NEWS2 scores to track patient acuity in ED. We have developed a free toolkit for implementing the ED Safety Checklist.
Read our ED Safety Checklist case study.
NEWS in community settings
We have teamed up with community providers to support the identification of the deteriorating patient. We continue working closely with each system to help raise the profile of NEWS2 across the different settings. Read our examples of NEWS being used in practice.
We have established the West of England Learning Disabilities Collaborative, made up of professionals, experts by experience, families and carers. By applying our learning from the region-wide rollout of NEWS, we aim to reduce premature mortality and improve health outcomes for people with learning disabilities.
The British Geriatrics Society (BGS) released a paper COVID-19: Managing the COVID-19 pandemic in care homes which offered 13 key recommendations to help all care home staff to support residents through the pandemic. This guidance recommends care home staff should be trained to spot the early warning signs of residents becoming unwell, where possible using the RESTORE2 tool or soft signs using RESTORE2 mini.
We have developed free resources and training packages support care home staff.
The BGS guidance also recommends that care home staff work with residents’ GPs to review Advance Care Plans as a matter of urgency with residents.
NEWS in primary care
We have produced free supporting information in postcard and business card size:
If you are an EMIS user you have access to a NEWS template. This video explains how to set it up.
We also have a template available in SystemOne, please email our patient safety team for more information.
Tying all of this work together, we have run various collaborative cross-sector learning set events with hundreds of attendees from healthcare providers across the region and beyond.
NEWS in mental health settings
All NHS mental health care providers in the West of England use NEWS to help identify physical deterioration in service users.
We worked with a medical student from the University of Bristol who was on an elective QI placement with North Bristol NHS Trust, to evaluate use of NEWS in Avon and Wiltshire Mental Health Partnership NHS Trust’s eating disorders unit.
BMJ Emergency Medicine Journal: NEWS used without clinical judgement is of limited value (A response to the Finnikin paper ‘Are referrals to hospital from out-of-hours primary care associated with National Early Warning Scores?’
- A regional approach to improving health outcomes for people with a learning disability, 24 April 2019, Bristol
- NEWS2: A progress update, 17 October 2018, Cheltenham
- The Deteriorating Patient: Reach for the Charts, 15 March 2018, Bristol
- NEWS2: The Next Generation, 28 September 2017, Bristol
- Let the numbers do the talking: NEW event 2 years on: 16 March 2017, Bristol.
- The deteriorating patient: handover to me, handover to you: 15 September 2016, Bristol
- Share the News – Safer Care Through Early Warning Scores Workshop: 10 March 2016, Swindon
- Safer Care Through Early Warning Scores: 17 September 2015, Bath
- Patient Safety Workshop – A Single Early Warning Score for the West of England: 5 March 2015, Bristol