Objectives: To evaluate implementation of EHR-integrated NEWS2 in a cardiac care setting and a general hospital setting in the COVID-19 pandemic. Design: Thematic analysis of qualitative semi-structured interviews with purposefully sampled nurses and managers, as well as online surveys. Settings: Specialist cardiac hospital (St Bartholomews Hospital) and General teaching hospital (University College London Hospital). Participants: Eleven nurses and managers from cardiology, cardiac surgery, oncology, and intensive care wards (St Bartholomews) and medical, haematology and intensive care wards (UCLH) were interviewed and sixty-seven were surveyed online. Results: Three main themes emerged: (i) Implementing NEWS2 challenges and supports; (ii) Value of NEWS2 to alarm, escalate, particularly during the pandemic; and (iii) Digitalisation: EHR integration and automation. The value of NEWS2 was partly positive in escalation, yet there were concerns by nurses who undervalued NEWS2 particularly in cardiac care. Challenges, like clinicians' behaviours, lack of resources and training and the perception of NEWS2 value, limit the success of this implementation. Changes in guidelines in the pandemic have led to overlooking NEWS2. EHR integration and automated monitoring are improvement solutions that are not fully employed yet. Conclusion: Whether in specialist or general medical settings, the health professionals implementing EWS in healthcare face cultural and systems related challenges to adopting NEWS2 and digital solutions. The validity of NEWS2 in specialised settings and complex conditions is not yet apparent and requires comprehensive validation. EHRs integration and automation are powerful tools to facilitate NEWS2 if its principles are reviewed and rectified, and resources and training are accessible. Further examination of implementation from the cultural and automation domains are needed.

BackgroundThe quality of recording and documentation of deteriorating patient management by health professionals has been challenged during the COVID-19 pandemic. Non-adherence to escalation and documentation guidelines increases risk of serious adverse events. Electronic health record (EHR)-integrated dashboards are auditing tools of patients’ status and clinicians’ performance, but neither the views nor the performance of health professionals have been assessed, relating to management of deteriorating patients.ObjectiveTo develop and evaluate a real-time dashboard of deteriorating patients’ assessment, referral and therapy.SettingsFive academic hospitals in the largest National Health Service (NHS) trust in the UK (Barts Health NHS Trust).InterventionThe dashboard was developed from EHR data to investigate patients with National Early Warning Score (NEWS2)>5, assessment, and escalation of deteriorating patients. We adopted the Plan, Do, Study, Act model and Standards for Quality Improvement Reporting Excellence framework to evaluate the dashboard.DesignMixed methods: (1) virtual, face-to-face, interviews and (2) retrospective descriptive EHR data analysis.ResultsWe interviewed three nurses (two quality and safety and one informatics specialists). Participants perceived the dashboard as a facilitator for auditing NEWS2 recording and escalation of care to improve practice; (2) there is a need for guiding clinicians and adjusting data sources and metrics to enhance the functionality and usability. Data analysis (2019–2022) showed: (1) NEWS2 recording has gradually improved (May 2021–April 2022) from 64% to 83%;(2) referral and assessment completion increased (n: 170–6800 and 23–540, respectively).ConclusionThe dashboard is an effective real-time data-driven method for improving the quality of managing deteriorating patients. Integrating health systems, a wider analysis NEWS2 and escalation of care metrics, and clinicians’ learning digital solutions will enhance functionality and experience to boost its value. There is a need to examine the generalisability of the dashboard through further validation and quality improvement studies.