scholarly journals Distribution of the National Early Warning Score (NEWS) in care home residents

2019 ◽  
Vol 49 (1) ◽  
pp. 141-145 ◽  
Author(s):  
Robert Oliver Barker ◽  
Rachel Stocker ◽  
Siân Russell ◽  
Anthony Roberts ◽  
Andrew Kingston ◽  
...  
Keyword(s):  
Older Adults ◽  
Early Warning ◽  
Care Home ◽  
Descriptive Analysis ◽  
Vital Signs ◽  
Acute Illness ◽  
Care Homes ◽  
Early Warning Score ◽  
Care Home Resident ◽  
National Early Warning Score

Abstract Background the National Early Warning Score (NEWS) is a tool based on vital signs that aims to standardise detection of, and response to, clinical deterioration in adults. NEWS has been adopted in hospitals but not adapted for other settings. This study aimed to explore the feasibility of measuring the NEWS in care homes and describe the distribution of NEWS readings amongst care home residents. Methods descriptive analysis of all NEWS readings recorded in a 30-month period (2016–19) across 46 care homes in one Clinical Commissioning Group in England. Comparisons were made between measurements taken as a routine reading and those prompted by concern about acute illness. Results a total of 19,604 NEWS were recorded from 2,424 older adults (≥65 years; mean age 85). Median NEWS was 2. Two thirds (66%) of residents had a low NEWS (≤2), and 28% had a score of 0. Of the total NEWS readings, 6,277 (32%) were known to be routine readings and 2,256 (12%) were measured because of staff concerns. Median NEWS was 1 for routine and 2 for concern recordings. Overall, only 12% of NEWS were high (≥5), but a higher proportion were elevated when there were concerns about acute illness (18%), compared with routine recordings (7%). Conclusions use of NEWS in care homes appears to be feasible. The majority of NEWS were not elevated, and the distribution of scores is consistent with other out-of-hospital settings. Further work is required to know if NEWS is triggering the most appropriate response and improving care home resident outcomes.

scholarly journals Implementation of the National Early Warning Score in UK care homes: a qualitative evaluation

2020 ◽  
Vol 70 (700) ◽  
pp. e793-e800
Author(s):  
Siân Russell ◽  
Rachel Stocker ◽  
Robert Oliver Barker ◽  
Jennifer Liddle ◽  
Joy Adamson ◽  
...  
Keyword(s):  
Early Warning ◽  
Care Home ◽  
Qualitative Evaluation ◽  
Acute Illness ◽  
Care Homes ◽  
Early Warning Score ◽  
Normalisation Process Theory ◽  
Home Setting ◽  
Care Home Staff ◽  
National Early Warning Score

BackgroundThe National Early Warning Score (NEWS) is a tool for identifying and responding to acute illness. When used in care homes, staff measure residents’ vital signs and record them on a tablet computer, which calculates a NEWS to share with health services. This article outlines an evaluation of NEWS implementation in care homes across one clinical commissioning group area in northern England.AimTo identify challenges to implementation of NEWS in care homes.Design and settingQualitative analysis of interviews conducted with 15 staff members from six care homes, five health professionals, and one clinical commissioning group employee.MethodInterviews were intended to capture people’s attitudes and experiences of using the intervention. Following an inductive thematic analysis, data were considered deductively against normalisation process theory constructs to identify the challenges and successes of implementing NEWS in care homes.ResultsCare home staff and other stakeholders acknowledged that NEWS could enhance the response to acute illness, improve communication with the NHS, and increase the confidence of care home staff. However, the implementation did not account for the complexity of either the intervention or the care home setting. Challenges to engagement included competing priorities, insufficient training, and shortcomings in communication.ConclusionThis evaluation highlights the need to involve care home staff and the primary care services that support them when developing and implementing interventions in care homes. The appropriateness and value of NEWS in non-acute settings requires ongoing monitoring.

scholarly journals Experiences of a National Early Warning Score (NEWS) intervention in care homes during the COVID-19 pandemic: a qualitative interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e045469
Author(s):  
Rachel Stocker ◽  
Siân Russell ◽  
Jennifer Liddle ◽  
Robert O Barker ◽  
Adam Remmer ◽  
...  
Keyword(s):  
Early Warning ◽  
Healthcare Professionals ◽  
Care Home ◽  
Qualitative Interview ◽  
Interview Study ◽  
Care Homes ◽  
Early Warning Score ◽  
Service Utilisation ◽  
Qualitative Interview Study ◽  
National Early Warning Score

BackgroundThe COVID-19 pandemic has taken a heavy toll on the care home sector, with residents accounting for up to half of all deaths in Europe. The response to acute illness in care homes plays a particularly important role in the care of residents during a pandemic. Digital recording of a National Early Warning Score (NEWS), which involves the measurement of physical observations, started in care homes in one area of England in 2016. Implementation of a NEWS intervention (including equipment, training and support) was accelerated early in the pandemic, despite limited evidence for its use in the care home setting.ObjectivesTo understand how a NEWS intervention has been used in care homes in one area of North-East England during the COVID-19 pandemic, and how it has influenced resident care, from the perspective of stakeholders involved in care delivery and commissioning.MethodsA qualitative interview study with care home (n=10) and National Health Service (n=7) staff. Data were analysed using thematic analysis.ResultsUse of the NEWS intervention in care homes in this area accelerated during the COVID-19 pandemic. Stakeholders felt that NEWS, and its associated education and support package, improved the response of care homes and healthcare professionals to deterioration in residents’ health during the pandemic. Healthcare professionals valued the ability to remotely monitor resident observations, which facilitated triage and treatment decisions. Care home staff felt empowered by NEWS, providing a common clinical language to communicate concerns with external services, acting as an adjunct to staff intuition of resident deterioration.ConclusionsThe NEWS intervention formed an important part of the care home response to COVID-19 in the study area. Positive staff perceptions now need to be supplemented with data on the impact on resident health and well-being, workload, and service utilisation, during the pandemic and beyond.

scholarly journals Impact of the level of sickness on higher mortality in emergency medical admissions to hospital at weekends

2017 ◽  
Vol 22 (4) ◽  
pp. 236-242 ◽  
Author(s):  
Mohammed Mohammed ◽  
Muhammad Faisal ◽  
Donald Richardson ◽  
Robin Howes ◽  
Kevin Beatson ◽  
...  
Keyword(s):  
Early Warning ◽  
Odds Ratio ◽  
Vital Signs ◽  
Early Warning Score ◽  
Emergency Admissions ◽  
Clinical Assessments ◽  
Admission Time ◽  
Emergency Medical ◽  
Acute Hospitals ◽  
National Early Warning Score

Objective Routine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time. Results Emergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p < 0.001) with a higher mortality (weekend: 706/11,332 6.23% vs. weekday: 2039/35,785 5.70%; odds ratio = 1.10, 95% CI 1.01 to 1.20, p = 0.04) which was no longer seen after adjusting for the index National Early Warning Score (odds ratio = 0.99, 95% CI 0.90 to 1.09, p = 0.87). Index National Early Warning Score was recorded sooner (−0.45 h, 95% CI −0.52 to −0.38, p < 0.001) for weekend admissions. Conclusions Emergency medical admissions at the weekend with electronic National Early Warning Score recorded within 24 h are sicker, have earlier clinical assessments, and after adjusting for the severity of their sickness, do not appear to have a higher mortality compared to weekday admissions. A larger definitive study to confirm these findings is needed.

scholarly journals National Early Warning Score 2 (NEWS2) and 3-level triage scale as risk predictors in frail older adults in the emergency department

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kirsi Kemp ◽  
Janne Alakare ◽  
Veli-Pekka Harjola ◽  
Timo Strandberg ◽  
Jukka Tolonen ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Hospital Admission ◽  
Early Warning ◽  
Early Warning Score ◽  
Predictive Values ◽  
Frail Older Adults ◽  
High Dependency ◽  
National Early Warning Score ◽  
Risk Predictors

Abstract Background The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED. Methods This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥ 75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-h and 30-day revisits, and ED length-of-stay (LOS). Results A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 h and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU. With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64–0.76) and 0.62 (0.56–0.68); for hospital admission prediction 0.62 (0.60–0.65) and 0.55 (0.52–0.56), and for HDU admission 0.72 (0.61–0.83) and 0.80 (0.70–0.90), respectively. The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p = 0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p < 0.001) but not between the yellow/green groups (p = 0.59). There were 48 and 351 revisits within 72 h and 30 days, respectively. With NEWS2 AUCs for 72-h and 30-day revisit prediction were 0.48 (95% CI 0.40–0.56) and 0.47 (0.44–0.51), respectively; with triage score 0.48 (0.40–0.56) and 0.49 (0.46–0.52), respectively. Conclusions The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission.

scholarly journals National Early Warning Score 2 (NEWS2) and 3-Level Triage Scale as Risk Predictors in Frail Older Adults in the Emergency Department

2020 ◽  
Author(s):  
Kirsi Kemp ◽  
Janne Alakare ◽  
Veli-Pekka Harjola ◽  
Timo Strandberg ◽  
Jukka Tolonen ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Hospital Admission ◽  
Early Warning ◽  
Early Warning Score ◽  
Predictive Values ◽  
Frail Older Adults ◽  
High Dependency ◽  
National Early Warning Score ◽  
Risk Predictors

Abstract Background The aim of the emergency department (ED) triage is to recognize critically ill patients and to allocate resources. No strong evidence for accuracy of the current triage instruments, especially for the older adults, exists. We evaluated the National Early Warning Score 2 (NEWS2) and a 3-level triage assessment as risk predictors for frail older adults visiting the ED.Methods This prospective, observational study was performed in a Finnish ED. The data were collected in a six-month period and included were ≥75-year-old residents with Clinical Frailty Scale score of at least four. We analyzed the predictive values of NEWS2 and the three-level triage scale for 30-day mortality, hospital admission, high dependency unit (HDU) and intensive care unit (ICU) admissions, a count of 72-hour and 30-day revisits, and ED length-of-stay (LOS). Results A total of 1711 ED visits were included. Median for age, CFS, LOS and NEWS2 were 85 years, 6 points, 6.2 hours and 1 point, respectively. 30-day mortality was 96/1711. At triage, 69, 356 and 1278 of patients were assessed as red, yellow and green, respectively. There were 1103 admissions, of them 31 to an HDU facility, none to ICU.With NEWS2 and triage score, AUCs for 30-day mortality prediction were 0.70 (0.64-0.76) and 0.62 (0.56-0.68); for hospital admission prediction 0.62 (0.60-0.65) and 0.55 (0.52-0.56), and for HDU admission 0.72 (0.61-0.83) and 0.80 (0.70-0.90), respectively.The NEWS2 divided into risk groups of low, medium and high did not predict the ED LOS (p=0.095). There was a difference in ED LOS between the red/yellow and as red/green patient groups (p<0.001) but not between the yellow/green groups (p=0.59).There were 48 and 351 revisits within 72 hours and 30 days, respectively. With NEWS2 AUCs for 72-hour and 30-day revisit prediction were 0.48 (95% CI 0.40-0.56) and 0.47 (0.44-0.51), respectively; with triage score 0.48 (0.40-0.56) and 0.49 (0.46-0.52), respectively.Conclusions The NEWS2 and a local 3-level triage scale are statistically significant, but poor in accuracy, in predicting 30-day mortality, and HDU admission but not ED LOS or revisit rates for frail older adults. NEWS2 also seems to predict hospital admission

scholarly journals Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in-hospital mortality in elderly patients in the pre-hospital setting and in the emergency department

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6947 ◽  
Author(s):  
Toshiya Mitsunaga ◽  
Izumu Hasegawa ◽  
Masahiko Uzura ◽  
Kenji Okuno ◽  
Kei Otani ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Early Warning ◽  
Pressure Pulse ◽  
Vital Signs ◽  
Early Warning Score ◽  
Single Centre ◽  
Peripheral Oxygen Saturation ◽  
Significant Difference ◽  
National Early Warning Score

The aim of this study is to evaluate the usefulness of the pre-hospital National Early Warning Score (pNEWS) and the pre-hospital Modified Early Warning Score (pMEWS) for predicting admission and in-hospital mortality in elderly patients presenting to the emergency department (ED). We also compare the value of the pNEWS with that of the ED NEWS (eNEWS) and ED MEWS (eMEWS) for predicting admission and in-hospital mortality. This retrospective, single-centre observational study was carried out in the ED of Jikei University Kashiwa Hospital, in Chiba, Japan, from 1st April 2017 to 31st March 2018. All patients aged 65 years or older were included in this study. The pNEWS/eNEWS were derived from seven common physiological vital signs: respiratory rate, peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate and Alert, responds to Voice, responds to Pain, Unresponsive (AVPU) score, whereas the pMEWS/eMEWS were derived from six common physiological vital signs: respiratory rate, peripheral oxygen saturation, body temperature, systolic blood pressure, pulse rate and AVPU score. Discrimination was assessed by plotting the receiver operating characteristic (ROC) curve and calculating the area under the ROC curve (AUC). The median pNEWS, pMEWS, eNEWS and eMEWS were significantly higher at admission than at discharge (p < 0.001). The median pNEWS, pMEWS, eNEWS and eMEWS of non-survivors were significantly higher than those of the survivors (p < 0.001). The AUC for predicting admission was 0.559 for the pNEWS and 0.547 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting admission (p = 0.102). The AUCs for predicting in-hospital mortality were 0.678 for the pNEWS and 0.652 for the pMEWS. There was no significant difference between the AUCs of the pNEWS and the pMEWS for predicting in-hospital mortality (p = 0.081). The AUC for predicting admission was 0.628 for the eNEWS and 0.591 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting admission (p < 0.001). The AUC for predicting in-hospital mortality was 0.789 for the eNEWS and 0.720 for the eMEWS. The AUC of the eNEWS was significantly greater than that of the eMEWS for predicting in-hospital mortality (p < 0.001). For admission and in-hospital mortality, the AUC of the eNEWS was significantly greater than that of the pNEWS (p < 0.001, p < 0.001), and the AUC of the eMEWS was significantly greater than that of the pMEWS (p < 0.01, p < 0.05). Our single-centre study has demonstrated the low utility of the pNEWS and the pMEWS as predictors of admission and in-hospital mortality in elderly patients, whereas the eNEWS and the eMEWS predicted admission and in-hospital mortality more accurately. Evidence from multicentre studies is needed before introducing pre-hospital versions of risk-scoring systems.

scholarly journals Do medical students recognise the deteriorating patient by analysing their vital signs? A monocentric observational study based on the National Early Warning Score 2

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044354
Author(s):  
David Alexander Christian Messerer ◽  
Michael Fauler ◽  
Astrid Horneffer ◽  
Achim Schneider ◽  
Oliver Keis ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Response ◽  
Early Warning ◽  
Vital Signs ◽  
Early Warning Score ◽  
Professional Activity ◽  
Monitoring Frequency ◽  
National Early Warning Score ◽  
Deteriorating Patient ◽  
Current Risk

ObjectiveAssessment of the expertise of medical students in evaluating vital signs and their implications for the current risk of a patient, an appropriate monitoring frequency, and a proper clinical response.Methods251 second-year and 267 fifth-year medical students in a curriculum consisting of 6 years of medical school at Ulm University, Germany, were interviewed in a paper-based questionnaire. The students were asked to rate their proficiency in interpreting vital signs and to give pathological thresholds of vital signs. Based on the National Early Warning Score 2 (NEWS2), nine vital signs of fictional patients were created and students were asked to comment on their clinical risk, to set an appropriate monitoring frequency as well as a clinical response.ResultsInterviewing medical students regarding each vital sign individually, the students indicated a pathological threshold in accordance with the NEWS2 for respiratory rate, temperature, and heart rate. By contrast, inappropriate pathological limits were given regarding oxygen saturation and systolic blood pressure. Translating the vital signs into nine fictional patients, fifth-year medical students overall chose an appropriate response in 78% (67%−78%, median±IQR). In detail, fifth-year students successfully identified patients at very high or low risk and allocated them accordingly. However, cases on the edge were often stratified inappropriately. For example, a fictional case with vital signs indicating a surging sepsis was frequently underappreciated (48.5%) and allocated to an insufficient clinical response by fifth-year students.ConclusionsRecognising the healthy as well as the deteriorating patient is a key ability for future physicians. NEWS2-based education might be a valuable tool to assess and give feedback on student’s knowledge in this vital professional activity.

scholarly journals Abbreviated National Early Warning Score predicts the need for hospital admission and in-hospital mortality in elderly patients

2018 ◽  
Vol 14 (3) ◽  
Author(s):  
Toshiya Mitsunaga ◽  
Masahiko Hujita ◽  
Izumu Hasegawa ◽  
Kei Otani ◽  
Kenji Okuno ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Mortality ◽  
Early Warning ◽  
Roc Analysis ◽  
Pressure Pulse ◽  
Vital Signs ◽  
Early Warning Score ◽  
Operating Characteristics ◽  
Peripheral Oxygen Saturation ◽  
National Early Warning Score

The aim of this study was to evaluate the value of the Abbreviated National Early Warning Score (aNEWS) for predicting admissions and in-hospital mortality in elderly patients present to Emergency Department (ED). This retrospective, single-centred observational study was carried out in the ED of Minamitama Hospital, in Tokyo, Japan from 1 April 2018 to 30 April 2018. All of the patients aged 65 and older were included in this study. The aNEWS is based on six common physiological vital signs, including peripheral oxygen saturation, the presence of inhaled oxygen parameters, body temperature, systolic blood pressure, pulse rate, and the Alert, responds to Voice, responds to Pain, Unresponsive score. The scores range from 0 and 3 for each parameter. The aNEWS ranged from a score of 0 to a maximum of 17. The receiver operating characteristics (ROC) analysis was used to evaluate the predictive value of the aNEWS for admission and in-hospital mortality. The median aNEWS of patients admitted to the hospital was significantly higher than that of patients discharged from the ED (P<0.001). The median aNEWS of survivors was significantly higher than that of non-survivors (P<0.001). The Areas under the ROC Curve (AUC) for predicting admission was 0.773 [95% CI 0.7142 to 0.8317, P<0.001] for the aNEWS. The AUC for predicting in-hospital mortality was 0.791 [95% CI 0.604 to 0.978, P<0.001] for the aNEWS. Our single-centred study has demonstrated the utility of the aNEWS as a predictor of patient admission and in-hospital mortality in elderly patients.

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