NEWS in out-of-hospital settings can be effective but needs careful implementation

29 October 2018

National Institute for Health Research (NIHR) funded researchers have found that the National Early Warning Score (NEWS) can help healthcare staff working in a range of community and out-of-hospital settings.  The score can support decisions on patient care and help communication with other healthcare professionals. However, incorporating the score into some settings is not straightforward and implementation should be tailored to different types of healthcare organisations.

Using NEWS to monitor patients is now standard practice in hospitals, and the West of England Academic Health Science Network (AHSN) are encouraging its use in out-of-hospital settings such as GP practices, the ambulance service, community and mental health services.

Researchers from the NIHR Collaboration for Leadership in Applied Health Research and Care West (CLAHRC West) worked with the West of England AHSN to evaluate the use of NEWS in out-of-hospital settings.

They interviewed out-of-hospital healthcare staff, who said that NEWS could help them make decisions about the level and priority of care their patients needed. The score could also provide a clear way of communicating concern about a patient to other healthcare professionals, although this was reliant on widespread take up and use across services.

NEWS is designed to be used alongside healthcare professionals’ clinical judgement rather than instead of it. Staff in the study liked the way that the tool could support and check their clinical assessment of a patient, but there were times when they experienced tension between what NEWS was suggesting they should do and their own clinical judgement.

The ability to incorporate NEWS into day-to-day work varied in different services. Ambulance paramedics used NEWS with all patients and it fitted into their routine. GPs had to select which patients to use NEWS with, and sometimes had to adapt their usual ways of assessing a patient in order to include NEWS. In community services and mental health, staff reported adapting NEWS to make it relevant to some patients.

This interview study demonstrated that NEWS can work for healthcare staff outside acute hospitals, but in some services it is not straightforward to incorporate into routine clinical practice. A tailored approach to introducing NEWS to different settings – for example with guidance for staff based on evidence from similar services and patient groups to their own – may be helpful, and increase staff confidence in NEWS.

Paper

Using the National Early Warning Score (NEWS) outside acute hospital settings – a qualitative study of staff experiences in the West of England

Emer Brangan, Jonathan Banks, Heather Brant, Anne Pullyblank, Hein le Roux, Sabi Redwood

Published in BMJ Open