National Early Warning Score (NEWS) 2

NEWS2 is the latest version of the National Early Warning Score (NEWS), first produced in 2012 and updated in December 2017, which advocates a system to standardise the assessment and response to acute illness.

COVID-19 update: See our new guidance on using NEWS2 to manage deterioration in patients with COVID-19

The RCP has also produced supplementary guidance to support implementation of NEWS2. Advice is given in five categories – new confusion, escalation/response guidance, oxygen scales, receiving acute patients into hospital, and what to do when the NEWS2 scores are incomplete.

NEWS2 has received formal endorsement from NHS England and NHS Improvement to become the early warning system for identifying acutely ill patients – including those with sepsis – in hospitals in England. To support the safe adoption of NEWS2, NHS Improvement has produced a resource pack.

How NEWS works

The NEWS is based on a simple aggregate scoring system in which a score is allocated to physiological measurements, already recorded in routine practice, when patients present to, or are being monitored in hospital. Six simple physiological parameters form the basis of the scoring system:

respiration rate
oxygen saturation
systolic blood pressure
pulse rate
level of consciousness or new confusion*
temperature.

*The patient has new-onset confusion, disorientation and/or agitation, where previously their mental state was normal – this may be subtle. The patient may respond to questions coherently, but there is some confusion, disorientation and/or agitation. This would score 3 or 4 on the GCS (rather than the normal 5 for verbal response), and scores 3 on the NEWS system.

A score is allocated to each parameter as they are measured, with the magnitude of the score reflecting how extremely the parameter varies from the norm. The score is then aggregated and uplifted by 2 points for people requiring supplemental oxygen to maintain their recommended oxygen saturation.

This is a pragmatic approach, with a key emphasis on system-wide standardisation and the use of physiological parameters that are already routinely measured in NHS hospitals and in prehospital care, recorded on a standardised clinical chart – the NEWS2 chart.

Permissions

The RCP is keen to encourage as many people as possible to use NEWS, so there is no copyright restriction on the NEWS2 report. However, anyone who is looking to reproduce material from the report should meet the following conditions.

The RCP should be acknowledged as follows: Reproduced from: Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017.
The material must not be modified/amended in any way.
The NEWS2 charts must be reproduced in full colour.
Please use the high-resolution versions of the chart attached to this page. Do not use the low-quality version in the report itself.