A study to introduce National Early Warning Scores (NEWS) in care homes: Influence on decision‐making and referral processes

Abstract

Early warning scores (EWS) are tools designed to detect patients at risk of unexpected catastrophic deterioration in general, acute ward situations. Morgan et al. (1997) observed that many patients who were unexpectedly admitted to ICU had shown minor, premonitory disturbances of their physiology for several hours before action was taken. They suggested that early intervention on detection of these signs might improve patient outcomes and proposed a score system aggregated from ratings of vital signs that could be used to trigger intervention (Morgan et al., 1997). A wide variety of EWSs were subsequently developed (Downey, 2017. A rapid response system (RRS) comprises an EWS and a protocol for the urgent review of patients who reach a "trigger" level (Al-Qahtani & Al-Dorzi, 2010).It has proved difficult to demonstrate that any of these activities reduce morbidity and mortality in ways that can be attributed

Use of a digital application to enhance communication and triage between care homes and National Health Service community services in the United Kingdom: a qualitative evaluation

“…Such interventions use smart devices for the transfer of data such as vital signs observations for the calculation of Early Warning Scores. The National Early Warning Score (NEWS) has been a common component of digital interventions within care homes and community NHS settings (Brangan et al, 2018; Hodgson et al, 2022; Russell et al, 2020; Scott et al, 2019; Stocker et al, 2021) and is being implemented in other countries including Norway (Steinskog et al, 2021). Such interventions have met with some success, including improving communication between health care services and care homes, and instilling confidence in care home staff (Hodgson et al, 2022; Oung, 2021; Scott et al, 2019; Stocker et al, 2021) though the complexity of the care home setting may present barriers (Russell et al, 2020).…”

“…The National Early Warning Score (NEWS) has been a common component of digital interventions within care homes and community NHS settings (Brangan et al, 2018; Hodgson et al, 2022; Russell et al, 2020; Scott et al, 2019; Stocker et al, 2021) and is being implemented in other countries including Norway (Steinskog et al, 2021). Such interventions have met with some success, including improving communication between health care services and care homes, and instilling confidence in care home staff (Hodgson et al, 2022; Oung, 2021; Scott et al, 2019; Stocker et al, 2021) though the complexity of the care home setting may present barriers (Russell et al, 2020). The need for remote communication between care homes and services produced by the COVID-19 pandemic has led to increased use of and support for digital interventions within care homes (BGS, 2021; Chu et al, 2021; Edelman et al, 2020; Stocker et al, 2021).…”

Early warning scores and trigger recommendations must be used with care in older home nursing care patients: Results from an observational study

“…Despite radically different contexts, early warning score (EWS) tools are recommended in both hospital and community care settings to detect early clinical deterioration and to support clinical decisions in cases of clinical deterioration (NICE, 2007 ; The Norwegian Directorate of Health, 2020 ). The implementation of various EWS in home nursing care, care homes and skilled nursing homes is ongoing, and research exploring how EWSs are used and how they impact clinical practice is increasing (Ammitzbøll & Maarslet, 2015 ; Barker et al, 2020 ; Brangan et al, 2018 ; Hodgson et al, 2022 ; Jeppestøl et al, 2022a ). Normal and pathological physiological changes are well known to occur with aging (Chester & Rudolph, 2011 ; Churpek et al, 2015 ), and older peoples' vital signs often deviate from standard reference values.…”

“…Suspicion of acute functional decline initiates a process in which healthcare professionals must assess the likelihood of acute illness (Hébert, 1997 ). Health professionals decide whether referral for medical service is needed and how quickly it must occur by comparing the changes in functional abilities and vital signs to the patient's normal and stable habitual state, taking the rapidity of the changes into account (Jeppestøl et al, 2022a ; Hodgson et al, 2022 ).…”

“…Research describing EWS characterizations, specifically among older care home residents, found a statistically significant link between older care home patients' EWS and Barthel ADL scores and healthcare personnel's reported role empowerment, improved communication and decision‐making with the use of EWS (Hodgson et al, 2022 ). Hodgson et al ( 2022 ) concluded that although EWS is a useful tool, it could not be used as a diagnostic tool for clinical deterioration due to the complexity of older care home patients' health condition. The authors suggested using additional assessment tools, such as the Barthel ADL or Rockwool Frailty scale, to support assessments of changes in health conditions.…”