Researchers from CLAHRC West presented their evaluation of the National Early Warning Score (NEWS) on 15 March 2018 at the ‘Deteriorating Patient: Reach for the Charts’ event. The event was hosted by our research collaborators the West of England Academic Health Sciences Network (AHSN).
The NEWS is a ‘track and trigger’ scoring tool that supports health care professionals to identify and respond to acutely unwell patients who are at risk of clinical deterioration. Originally designed to be used in hospitals, in 2015 the West of England AHSN identified the potential to use NEWS outside hospital and so developed an initiative to roll it out across the region.
With little published research on using NEWS in settings such as primary care and the ambulance service, the AHSN collaborated with CLAHRC West to evaluate the initiative. The ‘Deteriorating Patient’ event was an opportunity to share the results with the West of England AHSN network, including healthcare professionals who work with NEWS on a day-to-day basis in a range of settings.
The CLAHRC West team presenting were:
- Sabi Redwood – Deputy Director of CLAHRC West and ethnography team lead
- Manjual Nugawela – Research Associate
- Jon Banks – Research Fellow
- Lauren Scott – Senior Research Associate
Sabi presented the backstory to the collaboration and gave an overview of CLAHRC West, including how it supports local healthcare initiatives through evaluations, providing feedback and publishing findings to develop and support take up in the wider health care community.
The first part of the evaluation was presented by Manjula, who described the systematic reviews that the CLAHRC had done. Published research on NEWS and other early warning scores were examined and combined for a comprehensive analysis of whether they can predict outcomes. The team conducted two reviews, the first combined existing systematic reviews of the use of early warning scores in hospitals. The second looked at a smaller number of studies which had examined the use of other early warning scores outside hospital settings, particularly in the ambulance service. Manjula’s research highlighted the strength of early warning scores and the NEWS at either end of the scoring spectrum, ‘very low or high scores can identify patients not likely or likely to deteriorate’ but predictive accuracy was less certain for intermediate scores.
Jon then described the qualitative component of the evaluation. The qualitative team had interviewed over 25 health care professionals from a range of different health care sectors including:
- primary care
- the ambulance service
- community care
- mental health
The interviews gave health care professionals the opportunity to describe their experiences of working with NEWS in detail. The results highlighted the positive communicative aspects of the tool which gave people from different organisations the ability to talk to each other in a ‘common language’. It also supported decision making and prioritisation of patient care. However, Jon was also able to highlight the challenges faced by using the tool in these new settings and the interviews showed tensions around using the tool alongside clinical judgements. The findings also showed how different organisations faced different challenges in implementing and adopting the tool into everyday practice.
The last part of the evaluation was presented by Lauren who gave an overview of the quantitative analysis of the NEWS in the region. Lauren’s analyses used data from a number of organisations who had adopted NEWS and looked at the pattern of recorded NEWS scores. The data Lauren presented showed that high NEWS scores of five and over were relatively uncommon, only 8% of patients in one hospital ED and 32% of patients in a GP support team referral unit. Lauren was also able to show that as a NEWS score increases the time it takes for a patient to be treated decreases and their length of hospital stay increases. These data suggest the NEWS is working as it should and that it is a good indicator of how sick a patient is.
During the presentations, Anne Pulleyblank, the West of England AHSN clinical director for patient safety, gave some reflections on the impact of the research and what it meant to the AHSN. Sabi Redwood closed the CLAHRC’s presentation with some clear messages about implementation that can support the AHSN programme going forward as well as other regions looking to implement NEWS outside acute hospital settings. Sabi highlighted the value of tailoring implementation to different organisations who face different challenges in incorporating NEWS into their daily practice.
This event provided an overview of a successful collaboration – the combination of the West of England AHSN taking the initiative to introduce NEWS into new untested settings, along with the CLAHRC’s research resources to evaluate and provide evidence to strengthen the implementation and effective use of NEWS locally and nationally.