A new working party report from the Royal College of Physicians (RCP) says there should be a national system for recognising very sick patients whose condition is deteriorating and who need more intensive medical or nursing care. 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.
Speaking at a press conference to launch the National Early Warning Score, Professor Bryan Williams, chair of the working party, estimated that 6,000 lives could be saved by its use.*
The report, National early warning score (NEWS); standardising the assessment of acute-illness severity in the NHS, was produced by a multidisciplinary working group including doctors, nurses and managers. 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 (RCN), the National Outreach Forum, and NHS Training for Innovation.
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.
At present, NHS 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.
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
- standardise the training of all staff engaged in the care of patients in hospitals in the National Early Warning Score 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
- provide standardised data on regional variations in illness severity and resource requirements, as well as objective measurements of illness severity and clinical outcomes – an invaluable research resource.
How does it work?
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.
NEWS also has detailed recommendations on the actions for each score. For example, a medium score should prompt an urgent review by a clinical skilled with competencies in the assessment of acute illness – usually a ward-based doctor or acute team nurse, who should consider if a critical care outreach team is needed.
The National Early Warning Score developed by the working party was evaluated against many existing systems and found to be as good as the best of existing systems and better than others. At the recommended trigger levels for a clinical alert, NEWS is also more sensitive than most existing systems.
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.
Professor Derek Bell, chair of the NEWS educational subgroup, said:
Developing and adopting a standardised early warning system will be one of the most significant developments in health care in the next decade. It will provide a platform for education and training at all levels of staff and will also allow us to undertake better research into patient outcomes and improve patient safety.
RCN director of nursing and service delivery, Janet Davies said:
There is nothing nurses and doctors should prioritise more than patient safety, and this system, if implemented across the board, will be a great leap forward for patient care. Excellent systems for recognising patient deterioration do exist in many care settings, and have undoubtedly saved many lives. However this is the first time clinical expertise and experience have come together to standardise the best of that practice. I hope that every Trust will read this report and adopt this system as soon as possible, as countless lives could be saved in the future by adopting this simple process.
- Visit the NEWS pages of the RCP website to download the report and resources
- Visit the BMJ Quality and Safety website to read the full article
- Access the NEWS elearning materials
* 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.