Are National Early Warning Scores calculated in primary care associated with clinical outcomes during subsequent secondary care admissions?

Conference: 
2020 SW SAPC Bristol
Talk Code: 
3B.3
Presenter: 
Lauren Scott
Co-authors: 
Niamh Redmond, Alison Tavare, Hannah Little, Seema SrivastavaAnne Pullyblank
Author institutions: 
1. National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) University Hospitals Bristol NHS Foundation Trust, Population Health Sciences University of Bristol, West of England Academic Health Science Network, North Bristol NHS Trust

Problem

The National Early Warning Score (NEWS) is calculated from a series of physiological observations and was developed as a standardised measure to aid recognition of patient deterioration. NHS England has mandated the use of NEWS, more recently NEWS2, in acute settings, and recommended its use in pre-hospital settings including primary care. However, there is reluctance from General Practitioners (GPs) to adopt NEWS/NEWS2 as there is little evidence about its effectiveness in this setting. This study aimed to assess whether NEWS calculated and communicated by GPs at the point of referral into hospital was associated with speed of movement through the care pathway and clinical outcomes in secondary care.

Approach

Between July 2017 and December 2018, data were prospectively collected for 13,047 GP referrals into acute care. Multivariable linear and logistic regression models were used to assess associations between NEWS values recorded by GPs and 1) process measures including time from referral to hospital arrival and time from hospital arrival to medical review and 2) clinical outcomes including length of hospital stay (LOS), Intensive Care Unit (ICU) admission, sepsis and mortality.

Findings

Overall, 42% of patients had NEWS=0-2, 17% had NEWS=3-4, 11% had NEWS=5-6, 8% had NEWS=7+ and 22% had NEWS=NR (not recorded). Higher NEWS values were associated with increased LOS, ICU admissions, sepsis (suspected and diagnosed), and mortality (2-day and 30-day); decreased time from referral to arrival for patients conveyed by ambulance; and decreased time from arrival in hospital to medical review. The relationship between NEWS and conveyance time for patients using transport other than ambulance was unclear. On average, for patients referred without a NEWS value, most clinical outcomes were comparable to patients with NEWS=3-4; times from hospital arrival to medical review were longer for patients with NEWS=NR than for any calculated NEWS value.

Consequences

Our findings that NEWS values calculated in primary care are associated with clinical outcomes in subsequent secondary care admissions should go some way to increase GPs’ trust in using NEWS (now NEWS2) as a common language to communicate patient acuity to ambulance and hospital staff. GPs should be reassured that when used in conjunction with clinical judgement, calculating NEWS in primary care can improve clinical processes of assessment and treatment for patients.

Submitted by: 
Lauren Scott
Funding acknowledgement: 
This research was jointly funded by the National Institute for Health Research (NIHR) Applied Research Collaboration West (ARC West) at University Hospitals Bristol NHS Foundation Trust and the West of England Academic Health Science Network. The views expressed are those of the authors and not necessarily those of NHS England, NHS Improvement, the NIHR or the Department of Health and Social Care.