A CLAHRC West evaluation of routinely collected data has found that National Early Warning Scores (NEWS) are increasingly used in out-of-hospital settings in the West, and that high scores are reasonably uncommon in these settings.
The West of England Academic Health Science Network (AHSN) has been rolling out the use of NEWS in out-of-hospital settings across the region. This evaluation, the third paper from the CLAHRC West’s in-depth analysis of the roll out, adds to the evidence base on this topic.
Researchers looked at routinely collected data to establish what scores are recorded and how often NEWS is used. Data was collected from 115,030 emergency department attendances, 1,137,734 ambulance service records, 31,063 community health patients and 15,160 GP referrals into hospital. All four datasets included at least one year’s data, starting from April 2016.
The evaluation found a large proportion of patients had a NEWS between zero and two:
- 80 per cent in the emergency department
- 72 per cent in the community
- 67 per cent of ambulance patients
Only a small number of patients had a score of five or above, which is the trigger for hospital referral:
- 8 per cent in the emergency department
- 12 per cent in the community
- 18 per cent of ambulance patients
Referrals by a GP had higher scores on average, with 46 per cent of scores between zero and two, and 30 per cent of five or above.
Patients with higher scores on admission to the emergency department were more likely to be admitted to hospital, stay for longer, and were more likely to die, than patients with lower scores. For example, 94 per cent of patients with NEWS of seven or more were admitted to hospital or died, compared to 45 per cent of patients with a score of zero.
By April 2016, one year after the start of the roll-out, the use of NEWS was reasonably stable in the emergency department, ambulance and community populations, and still increasing for GP referrals.
These findings suggest that the West of England AHSN’s initiative to increase the use of NEWS has been successful and high scores are reasonably uncommon in most of these out-of-hospital settings.
Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out
Lauren Scott, Niamh Redmond, Joanna Garrett, Penny Whiting, Kate Northstone, Anne Pullyblank
Published in BMJ Emergency Medicine Journal