Alison Tavaré, Primary Care Clinical Lead writes about our work on the National Early Warning Score (NEWS), and where it might be heading in the future.
The National Early Warning Score (NEWS) has been a core part of our work in improving patient safety for nearly five years. The Patient Safety team at the West of England AHSN, which I am a part of, were clear from the start that we wanted to improve the care of very sick patients. NEWS and its more recent iteration, NEWS2, have been central to this work.
● NEWS and NEWS2, developed by the Royal College of Physicians, provide a numerical early warning score through the monitoring of six vital signs in a patient. Tracking a NEWS score throughout acute and community settings enables deterioration to be recognised, tracked and appropriately responded to at all stages of a patient’s journey. Its use improves communication between clinicians, from community or primary care, to the ambulance trusts, and on to hospital staff.
As a team we’ve rolled NEWS and NEWS2 out across the whole health system in our region. Our experience shows it works for clinicians on the front line and the data shows it has had significant impact, particularly in relation to sepsis. We’ve found that NEWS not only supports decisions on what care a patient should receive, but also decisions about where patients should be seen. It helps to ensure they can be seen ‘at the right time, in the right place and by the right person’.
This work has won awards and recognition for us and our partners, and more importantly it has saved lives and simplified systems for clinicians. We really started to understand the impact of the work when NHS Improvement undertook an analysis of the mortality from ‘suspicion of sepsis’. Using a tool called the suspicion of sepsis dashboard, developed by Imperial College Health Partners and NHS Improvement’s Patient Safety Measurement Unit found that mortality is lowest in the West of England, and that it continues to fall. They have called it ‘special cause variation’.
“Key to the success has been the collaboration and a real sense of shared purpose and responsibility across the region”
There are a number of reasons why the team has been successful. One is that NEWS is simple it does not require lots of expensive equipment and is based on usual clinical practice being done really well. Also key to the success has been collaboration and a real sense of shared purpose and responsibility across the region. As a GP, working with colleagues from across the NHS and learning so much from them has really added to the enthusiasm and momentum of the work.
Following the successful implementation in the West of England, NEWS2 is currently being implemented across the country. As Matt Inada-Kim, National Clinical Advisor on Sepsis (NHS England) and Deterioration (NHS Improvement), said: “I am so pleased for the West of England AHSN team. They have given the rest of the country a glimpse of what the NHS could be like in every part of the country.
“The standardisation across an entire region, with a single language of sickness, across all pathways of care and environments has demonstrably reduced deaths from suspicion of sepsis, and is a powerful example of the value of marrying quality improvement with outcomes data measurement.” ■
Next steps for NEWS
● After our success in other areas, we wondered if NEWS could be used to help identify sick patientsin settings such as care homes. Our focus on care homes is an intuitive move on many levels. There are over 11,000 care homes across the country housing over 400,000 residents, many of whom are likely to be frail and susceptible to illness. We are also moving into a world where health and social care are becoming increasingly joined-up.
We hope that providing care home staff with NEWS, to use as a common language to communicate with health professionals if they have concerns about a resident, will save time and confusion and improve care. If they have concerns about a resident, clear communication can save time and confusion and improve care. The challenge is how we work with care home staff to apply NEWS in a different setting, and the team are developing regional collaborations to support this work.
● Over recent years there has been mounting evidence of increased mortality amongst people with learning disabilities, particularly from sepsis. There are many possible reasons, such as long term illnesses making infection more likely. Also symptoms can be missed through something known as ‘diagnostic overshadowing’. This can occur if something like a change in behaviour, such as not wanting to get out of bed, is not understood to be due to infection, but instead is related to existing conditions.
Discussing this with our Medical Director, Anne Pullyblank, and our Director of Transformation, Kay Haughton we wondered if NEWS can play a role in helping clinicians pick up underlying deterioration. As we are natural collaborators we reached out to see if others would be interested in working on this. As a result we’ve uncovered an enormous desire to collaborate in this area. We had planned a small scoping event for about 40 people to explore possibilities. In the end we had to change venue to welcome over 150 people to what was a hugely positive and energising meeting. We heard from members of the learning disabilities community and ‘Misfits’ theatre company, which really helped ensure we understood the priorities. As a result we came away with lots of practical ideas and plans made to take this work forward. As team we are really excited to see where this energy and enthusiasm will take us.
Read more in our Innovating Together magazine – a look back at the work of the West of England AHSN in the year 2018-19, and a look ahead to some the work we have planned.Download it here as a PDF or read it below via Issuu.