The COVID-19 situation is rapidly changing and we recommend that GPs ensure they are receiving updates from their local system.
GPs can also review the current NHS guidance for primary care.
The AHSN Network also holds useful resources and information on Patient Safety in Primary Care during COVID-19.
As well as this, we have produced a RESTORE2 Poster for GP Practices.
GPs may be interested in our 2020 webinars delivered with the Royal College of GPs on COVID-19:
- COVID-19 and children: what the busy clinician needs to know
- Patient assessment – the role of physiology and oximetry
- Overview of training and digital support to Care Home staff
- Primary Care in Care Homes during COVID-19 webinar – AHSN Network event
GPs may also be interested in our webinar (for the West of England region) explaining the training and digital support available for care homes.
COVID Oximetry @home and COVID virtual wards
The West of England AHSN supported the roll-out of ‘COVID Oximetry @home’ and ‘COVID virtual wards’ in our region. Our local support offer made use of our existing expertise, infrastructure and resources.
NEWS and NEWS2
NEWS and the updated NEWS2 (National Early Warning Score) was developed by the Royal College of Physicians and is a structured set of observations based on a simple aggregate scoring system acting as ‘track and trigger’ and a common language across settings.
Watch an example of a patient story from our region where NEWS has been used to assess and trigger responses across patient pathways and ultimately improved outcomes for this patient.
Evidence is accumulating, such as the Scott et al finding, that the higher the NEWS the more likely a patient is to be admitted, the longer the length of stay and the more likely they are to die.
Concern has also been expressed that many people in the community will have a high NEWS due to underlying conditions. This has not been found to be the case. Barker et al case reviewed 19,604 NEWS from 2,424 older adults in 46 care homes over 30 month period; the median NEWS was 2, 66% had a NEWS of 2 or less and 28% had NEWS of 0.
National Early Warning Scores and component physiology in COVID-19 positive hospitalised patients in the West of England
In collaboration with ARC West, we’ve examined the impact of COVID-19 on NEWS2 across four acute hospital trusts. The study concluded NEWS2 is a reasonably good predictor of short-term mortality in this population, and the respiratory components are of the most value individually. These findings support the RCP’s recommendations to use NEWS2, alongside clinical judgement, in the assessment of COVID-19 patients. Read the NEWS pre-print study here.
NEWS2 and COVID-19
NEWS2 is recommended by the Royal College of Physicians to risk assess patients with COVID-19 or possible COVID-19 in hospital.
However, the Royal College of GPs position on COVID-19 and NEWS is that there is no validated scoring system for COVID-19. The RCGP also recommends that while recording physiological measures may be helpful in supporting decision-making it should be used alongside wider clinical assessment and not replace clinical judgement. Further research has been recommended by Prof Trish Greenhalgh and colleagues from the University of Oxford Centre for Evidence Based Medicine (CEBM).
The reasons for the caution are partly because it is not recommended that patients be seen for a face to face assessment solely for NEWS2 to be calculated. In addition, severe COVID-19 may present with unpredictable physiological change such as ‘silent hypoxia’ when someone does not appear unduly short of breath or cyanosed but may have reduced oxygen saturation.
RESTORE2, incorporates NEWS2, and was developed before COVID-19. However, the use of RESTORE2 provides a common language of communication with carers and enables the monitoring of physiological change and it is in this way that we recommend it is used. Watch our short RESTORE2 training video to find out how RESTORE2 benefits GPs. You can also find out more about this and our other training resources for care providers.
- BMJ Emergency Medicine Journal: Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out.
- Resuscitation: Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review
- BMJ Open: Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England.
- Nursing Standard: Adapting the NEWS early warning tool to assess patients in the community.
- Healthcare Manager: Early warnings save lives.