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 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 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, which seems to behave in ways not yet fully understood. 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. 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.