The West of England Patient Safety Collaborative has developed a programme, delivered by the West of England AHSN, encouraging the use of a single early warning score – the National Early Warning Score (NEWS) – across the region. NEWS2 is the latest version of the National Early Warning Sore, 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.
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).
NEWS in emergency departments
We are supporting the national adoption and spread of the Emergency Department Safety Checklist, piloted at University Hospitals Bristol NHS Foundation Trust and now used by all Emergency Departments in the West of England. The ED Safety 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.
NEWS in community settings
We have teamed up with our community providers supporting them with identification of the deteriorating patient in a community setting. We continue working closely with each CCG to help raise the profile of NEWS2 across the different settings. We have some brilliant examples of NEWS being used in practice.
A next step for our NEWS work is to expand its use into wider community settings. This includes a focus on people with learning disabilities. 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.
Recently, the British Geriatrics Society (BGS) released a paper, COVID-19: Managing the COVID-19 pandemic in care homes, offering 13 key recommendations to help all care home staff, and the NHS staff who work with you, to support residents through the pandemic. Read the BGS COVID-19 Paper here.
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. Read more about RESTORE2 here. View a PDF about Restore2 mini here.
We have developed free online videos and virtual (video-based) training to support you, and can also provide coaching, advice and guidance around these tools. Watch our care home videos here.
The guidance also recommends that care home staff work with residents’ GPs to review Advance Care Plans as a matter of urgency with residents. Read more about Advance Care Plans here.
NEWS in primary care
We have produced supporting information in postcard and business card size. You are welcome to download and use these for free:
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 also teamed up 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. Every person admitted to the unit has a personalised NEWS escalation trigger created, which is regularly reviewed to reflect gradual changes in their physiology. This was a truly collaborative project at the intersection between mental and physical health, involving the West of England AHSN and three of our member organisations. View a PDF presentation about the evaluation 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