Calculating early warning scores before they reach hospital can help the sickest patients

Press release issued: 7 April 2020

Recording National Early Warning Scores (NEWS) when a patient is urgently referred to hospital can improve the process of care for the sickest patients and reduce the time taken to get to hospital, according to a National Institute for Health Research (NIHR) funded study at the University of Bristol published in the British Journal of General Practice (BJGP) today [7 April]. National Early Warning Scores help clinicians recognise when patients are at risk of deterioration, for example as a result of infection such as sepsis.

The research team, based at the NIHR Applied Research Collaboration (ARC) West in collaboration with the West of England Academic Health Science Network (AHSN), studied the impact of NEWS scores collected for more than 13,000 urgent GP referrals to hospital. They found that higher scores are associated with patients being taken to hospital by ambulance more quickly. Average transfer time was 94 minutes for patients with the highest scores, compared with 132 minutes for those with the lowest. Patients with high scores were also reviewed more quickly after arriving at hospital.

Patients with higher scores were sicker, with longer hospital stays and more of them being admitted to intensive care. Patients with the highest scores were nearly five times more likely to have sepsis than those with the lowest scores and eight times more likely to die within two days of hospital admission.

Early warning scores (EWS) are designed to help healthcare staff identify patients whose condition is deteriorating, to allow them to get the treatment they need quickly. Higher scores indicate poorer health.

The National Early Warning Score (NEWS) is a simple scoring system of six clinical measurements which are added together to give an overall score, with various thresholds triggering different clinical responses.

National Early Warning Scores are already used in hospitals across England and by ambulance call handlers and paramedics for triage. However, they aren’t consistently used outside hospital and ambulance services, for example in GP surgeries and community settings.

The researchers also suggest that patients and carers could benefit from education about NEWS to enable the sickest patients to be transferred to hospital quickly.

These findings come at a time when the Royal College of General Practitioners (RCGP) is endorsing the use of NEWS in GP surgeries as part of a system-wide response to the COVID-19 pandemic, with new guidance for GPs issued last week in their COVID-19 resource hub.

Lauren Scott, Senior Research Associate at NIHR ARC West, said:"Ambulance call handlers, paramedics and hospital staff are already using NEWS to triage patients. We believe calculating NEWS at an earlier point in the patient pathway, in GP surgeries for example, could help the sickest patients receive timely care and therefore save lives. Our findings are particularly relevant in the context of the coronavirus pandemic, as some COVID-19 patients develop sepsis as a result of the infection.

"We found that higher NEWS values recorded at referral into hospital were associated with poorer clinical outcomes, which is to be expected as these patients will usually be the most ill. But we also found that higher NEWS scores meant patients conveyed by ambulance were taken to hospital more quickly, and were assessed more quickly when they got there."

Dr Alison Tavaré, GP and Primary Care Clinical Lead at the West of England AHSN, added: "As a GP I use NEWS alongside clinical judgement when arranging admissions to help secondary care colleagues decide where patients should be seen, by whom, and with what urgency. I feel strongly that NEWS also protects me as a clinician; if a patient unexpectedly has a high NEWS it makes me think ‘have I missed something?"

Dr Tavaré’s personal experience of being a patient with sepsis is also published in BJGP this week.

Paper

'Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care' Lauren J Scott, Niamh M Redmond, Alison Tavare, Hannah Little, Seema Srivastava and Anne Pullyblank in the British Journal for General Practice (BJGP)

Further information

About the National Institute for Health Research
The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

Funds, supports and delivers high quality research that benefits the NHS, public health and social care
Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research for the direct and primary benefit of people in low- and middle-income countries, using UK aid from the UK government.

About NIHR ARC West
The NIHR Applied Research Collaboration West (NIHR ARC West) co-produces better, more equitable, appropriate and sustainable health and care across the West. It does this through applied health research projects and implementing research evidence, regionally, nationally and internationally. Co-producing research with partner organisations and the people affected by the research is at its heart. To achieve this, its researchers work with health provider organisations, including local NHS and public health, the wider health and care sector including voluntary sector organisations, patients and the public, and other ARCs and academic groups.