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 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 project in the form of a 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 to tell this 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. A free NEWS2 toolkit is now available here.
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.
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. The guidance also recommends that care home staff work with residents’ GPs to review Advance Care Plans as a matter of urgency with residents.
Our online training session will help you keep your residents safe and healthy and quickly spot causes of deterioration. Book here for dates in May and June. If you would like to arrange bespoke training for your home, please email firstname.lastname@example.org
NEWS in primary care
If you would like a simple information sheet explaining what NEWS is and why it’s a relevant tool for primary care download it here.
If you are an EMIS user you have access to a NEWS template. This video explains how to set up: watch here. We also have a template available in SystemOne, please email email@example.com 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 recently 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. To see a presentation about the project, click here.
BMJ Emergency Medicine Journal: Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out: https://emj.bmj.com/content/early/2019/03/06/emermed-2018-208140
Resuscitation: Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review: https://www.sciencedirect.com/science/article/pii/S0300957218308190
BMJ Open: Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England: https://bmjopen.bmj.com/content/8/10/e022528.full
British Journal of General Practice: Implementation of the National Early Warning Score in patients with suspicion of sepsis: evaluation of a system-wide quality improvement project: https://bjgp.org/content/early/2020/04/08/bjgp20X709349
British Journal of General Practice: Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care: https://bjgp.org/content/early/2020/04/06/bjgp20X709337
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?’:
Nursing Standard: Adapting the NEWS early warning tool to assess patients in the community: Read the article
Healthcare Manager: Early warnings save lives: Read the article
If you would like to get involved or want more information, please contact the team at firstname.lastname@example.org.
- 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