References

Fullerton N, Price CL, Silvey NE, Brace SJ, Perkins GD Is the Modified Early Warning Score (MEWS) superior to clinician judgement in detecting critical illness in the pre-hospital environment?. Resuscitation. 2012; 83:(5)557-562 https://doi.org/10.1016/j.resuscitation.2012.01.004

Grant S Limitations of track and trigger systems and the National Early Warning Score. Part 1: areas of contention. Br J Nurs.. 2018; 27:(11)624-631 https://doi.org/10.12968/bjon.2018.27.11.624

Grant S, Crimmons K Limitations of track and trigger systems and the National Early Warning Score. Part 2: sensitivity versus specificity. Br J Nurs.. 2018; 27:(12)705-710 https://doi.org/10.12968/bjon.2018.27.12.705

McGinley A, Pearse RM A national early warning score for acutely ill patients. BMJ.. 2012; 345 https://doi.org/10.1136/bmj.e5310

Mohammed MA, Faisal M, Richardson D The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals. Clin Med.. 2019; 19:(2)104-108 https://doi.org/10.7861/clinmedicine.19-2-104

National Confidential Enquiry into Patient Outcome and Death.. 2017. https://tinyurl.com/yxj6kobp

National Confidential Enquiry into Patient Outcome and Death.. 2007. https://tinyurl.com/yyc8v3a8

NHS Improvement.. Patient safety measurement unit: NHS improvement. 2017. https://tinyurl.com/yy4vb5e7

NHS England.. 2019. https://tinyurl.com/y5qba6on

Resuscitation Council.. 2015. https://tinyurl.com/njg37xq

Patel R, Nugawela MD, Edwards HB Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review. Resuscitation.. 2018; 132:101-111 https://doi.org/10.1016/j.resuscitation.2018.08.028

Petersen JA, Mackel R, Antonsen K, Rasmussen LS Serious adverse events in a hospital using early warning score—what went wrong?. Resuscitation. 2014; 85:(12)1699-1703 https://doi.org/10.1016/j.resuscitation.2014.08.037

Pimentel MAF, Redfern OC, Gerry S A comparison of the ability of the National Early Warning Score and the National Early Warning Score 2 to identify patients at risk of in-hospital mortality: a multi-centre database study. Resuscitation. 2019; 134:147-156 https://doi.org/10.1016/j.resuscitation.2018.09.026

Roland D, Jahn H Are early warning scores too early for paramedic practice?. J Paramed Pract. 2012; 4:(1)16-21 https://doi.org/10.12968/jpar.2012.4.1.16

Royal College of Physicians.. 2012. https://tinyurl.com/yykycewp

Royal College of Physicians.. 2017. https://tinyurl.com/ycodbu85

Scott LJ, Redmond NM, Garrett J, Whiting P, Northstone K, Pullyblank A Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out. Emerg Med J.. 2019; 36:287-292 https://doi.org/10.1136/emermed-2018-208140

Smith GB, Prytherch DR, Schmidt PE, Featherstone PI Review and performance evaluation of aggregate weighted ‘track and trigger’ systems. Resuscitation.. 2008; 77:170-179 https://doi.org/10.1016/j.resuscitation.2007.12.004

A good idea badly implemented? Revised National Early Warning Score 2 in community settings

02 June 2019
Professional
02 June 2019
Volume 24 · Issue 6

Abstract

ABSTRACT

The revised National Early Warning Score (NEWS2), a tool used to measure acute deterioration in hospital, has been introduced in acute NHS hospitals and ambulance services. Community nurses report that when they call 999 requesting an ambulance to take a person to hospital, they are asked to provide a NEWS score. They report that when the NEWS score is high, ambulance staff prioritise the call. The NEWS score is being introduced in the community by default. This article will outline how the NEWS score is calculated, its uses and limitations and asks if the NEWS score accurately measures acute deterioration in people living in the community and predicts the need for referral to accident and emergency services.

Early warning scores (EWSs) are forms of track-and-trigger scoring systems that have been used in acute healthcare settings for many years. A report published in 2007 raised concerns regarding the lack of standardisation of EWSs across the NHS (National Confidential Enquiry into Patient Outcome and Death (NCEPOD), 2007). This led to the development of the National Early Warning System (NEWS) (Royal College of Physicians (RCP), 2012).

NEWS is a standardised tool that can be interpreted consistently by clinicians. Its use was recommended in acute settings across the NHS. NEWS uses six physiological measurements: respiratory rate, oxygen saturation, temperature, systolic blood pressure, heart rate and level of consciousness. Each scores 0–3, and individual scores are added together for an overall score. An additional 2 points are added if the patient is receiving oxygen therapy. The total possible score ranges from 0 to 20. The higher the score, the greater is the clinical risk for the patient. Higher scores indicate the need for escalation, medical review and possible clinical intervention, as well as more intensive monitoring (RCP, 2012).

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National Early Warning System
Community settings
Patient deterioration
Assessment
Emergency services