Hospital Dr News

National Early Warning Score could save lives

A national system is needed for recognising very sick patients whose condition is deteriorating and who need more intensive medical or nursing care, an RCP report claims.

Professor Bryan Williams, chair of the working party behind the report, estimates that 6,000 lives could be saved by its use.

The working party also developed and piloted a National Early Warning Score for this purpose, which if implemented across the NHS, would result in a step-change upwards in patient safety, the RCP claims.

Each acute hospital bed has a chart that is used to record measurements such as the patient’s pulse rate, blood pressure and temperature. These measurements help the nursing and medical teams decide the severity of illness of the patient and if the patient needs more urgent care.

However, at present, trusts use different early warning systems with different charts. As doctors and nurses move around different hospitals during their training and careers, they are not familiar with each trust’s system, resulting in a lack of consistency in detecting and responding to acutely ill patients.

There are more than 100 types of chart.

A recent study of 1,000 adults dying in acute hospitals in England published in BMJ Quality and Safety estimated that around one in 20 deaths (5.2%) in hospital was preventable, and estimated there would therefore have been 11,859 preventable deaths among adults in English acute hospitals. The study went on to analyse the causes of those deaths. 31.3% of those deaths were estimated to be from poor clinical monitoring, 29.7% from diagnostic errors and 21.1 % from inadequate drug or fluid management.

Professor Williams estimated that around 50% of these deaths, 6,000, could have been prevented by using the National Early Warning Score.

He said having one National Early Warning Score (NEWS) with the same charts in every hospital will provide the basis for a unified and systematic approach to both the first assessment of the patient and continuous tracking of their clinical condition throughout their stay, with a simple trigger for escalating their care.

It would also standardise the training of all staff engaged in the care of patients in hospitals in the NEWS system, so that staff should only need to be trained once instead of each time they move to a hospital that has a different system. And, according to the RCP, it would act as a research resource by providing standardised data on regional variations in illness severity and resource requirements, as well as objective measurements of illness severity and clinical outcomes.

NEWS is based on a simple scoring system in which a score is allocated to six physiological measurements already taken in hospitals – respiratory rate, oxygen saturations, temperature, systolic blood pressure, pulse rate and level of consciousness.

A score is allocated to each measurement. The more the measurements vary from what would have been expected (either higher or lower), the higher the score. The six scores are then aggregated to produce an overall score which, if high, will alert the nursing or medical team of the need to escalate the care of the patient.

Professor Bryan Williams, chair of the working party, said: “Many changes in health care are incremental but this new National Early Warning Score has the potential to transform patient safety in our hospitals and improve patient outcomes, it is hugely important.”

Commenting on the report, Society for Acute Medicine president Dr Chris Roseveare said: “Early Warning Scores are a key element of the initial assessment of patients admitted to acute medical units, and their importance is reflected in our recent Quality Standards document and Quality Indicators. We recommend that all patients should have an Early Warning Score at the time of admission to hospital with on-going regular monitoring. This is crucial to ensure recognition of deterioration in an acutely ill patient’s condition.”

Clinical observation charts and elearning materials were also produced by the NEWS educational programme, a collaborative project funded by the RCP, the Royal College of Nursing, the National Outreach Forum, and NHS Training for Innovation.

Click here for more on the elearning materials.

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2 Responses to “National Early Warning Score could save lives”

  1. Malcolm Morrison says:

    This is obviously good ‘NEWS’! The anaesthetists introduced a scoring system many years ago to determine anaesthetic ‘risk’; and the neurosurgeons have used the Glasgow Coma Scale to monitor brain damage in general and head injuries in particular.

    However, I find it odd that we need a ‘report’ to tell us that patients should have a chart of Temp. Pulse, and BP – a slight modification of the old ‘TPR’ (the ‘R’ being for respiration) chart, which every hopuseman and every ward sister looked at daily – or more often if the condition of the patient warranted it!

    I am always intrigued as to how these ‘estimates’ are arrived at. How do they decide (or should I say guess) how many ‘lives will be saved’? Or how many deaths were ‘preventable’? However, I note that nearly a third of the ‘preventable’ deaths were due to ‘poor clinical monitoring’ – maybe this means that doctors and nurses were looking at ‘results’ on the computer rather than looking at the patient!

    There may be a place for ‘standardisation’ of charts but, if they are ‘compulsory’ and ‘national’, they deny innovation. Doctors (and nurses) should know what is important, what to look for, and must look for it. And they MUST consult someone more senior if they are unable to deal with the situation themselves.
    Retired Orthopod

  2. Caroline whymark says:

    2 points: It’s a lovely idea in theory. While we’re at it we could standardise the drug charts, patients notes and the rest of the mountain of paperwork. This could only be achieved in a communist state. A department near me has 10 consultants and cannot agree on one uniform DVT prophylaxis protocol, another similar sized department allows individuals their own preference of antibiotic prophylaxis. Agreement will never happen. National paperwork would need to be imposed. Would it include devolved nations?

    Secondly, I have witnessed the death of many patients whose demise over the preceding hours has been beautifully, steadily, accurately and repeatedly charted. The dots and seagulls cross from green to yellow to red shaded areas of the chart yet the clinical course is unchanged. It’s not the charts fault. Oops out of space!!

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