A good idea badly implemented? Revised National Early Warning Score 2 in community settings
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.
References
- . 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 Crossref, Medline, Google Scholar
- . 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 Link, Google Scholar
- . 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 Link, Google Scholar
- . A national early warning score for acutely ill patients. BMJ. 2012; 345:e5310. https://doi.org/10.1136/bmj.e5310 Crossref, Medline, Google Scholar
- 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 Crossref, Medline, Google Scholar
National Confidential Enquiry into Patient Outcome and Death. Inspiring change: a review of the quality of care provided to patients receiving acute non-invasive ventilation. 2017. https://tinyurl.com/yxj6kobp (accessed 16 May 2019) Google ScholarNational Confidential Enquiry into Patient Outcome and Death. Emergency admissions: a journey in the right direction? 2007. https://tinyurl.com/yyc8v3a8 (accessed 16 May 2019) Google ScholarNHS Improvement. Patient safety measurement unit: NHS improvement. NEWS baseline survey. 2017. https://tinyurl.com/yy4vb5e7 (accessed 16 May 2019) Google ScholarNHS England. NEWS2. Frequently asked questions. 2019. https://tinyurl.com/y5qba6on (accessed 16 May 2019) Google ScholarNHS Improvement , Royal College of Physicians. NHS/PSA/RE/2018/003. Resources to support the safe adoption of the revised National Early Warning Score (NEWS2). 2018. https://tinyurl.com/y4nah4wf (accessed 16 May 2019) Google Scholar- ;
Resuscitation Council. Resuscitation guidelines 2015. 2015. https://tinyurl.com/njg37xq (accessed 16 May 2019) Google Scholar - 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 Crossref, Medline, Google Scholar
- . 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 Crossref, Medline, Google Scholar
- 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 Crossref, Medline, Google Scholar
- . 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 Link, Google Scholar
Royal College of Physicians. National Early Warning Score (NEWS): standardising the assessment of acute-illness severity in the NHS. 2012. https://tinyurl.com/yykycewp (accessed 16 May 2019) Google ScholarRoyal College of Physicians. National Early Warning Score (NEWS2) 2. 2017. https://tinyurl.com/ycodbu85 (accessed 16 May 2019) Google Scholar- . 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 Crossref, Medline, Google Scholar
- . 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 Crossref, Medline, Google Scholar



