Aggregate National Early Warning Score (NEWS) values are more important than high scores for a single vital signs parameter for discriminating the risk of adverse outcomes

Jarvis, Stuart; Kovacs, Caroline; Briggs, Jim; Meredith, Paul; Schmidt, Paul E.; Featherstone, Peter I.; Prytherch, David; Smith, Gary B.

doi:10.1016/j.resuscitation.2014.11.014

Cited by 60 publications

(51 citation statements)

References 17 publications

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“…finding that triggering on single extreme values of a vital sign observation, as suggested for NEWS by the RCPL, is not necessarily advantageous [23]. Finally, ours is a single centre study and similar results might not be obtained from data collected in other institutions.…”

Section: Discussionmentioning

confidence: 62%

Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest, death or unanticipated intensive care unit admission?

et al. 2015

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Section: Discussionmentioning

confidence: 62%

Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest, death or unanticipated intensive care unit admission?

et al. 2015

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“…Over the past two decades, an expansive body of literature related to the RRS has emerged. In relation to the afferent limb of the RRS specifically, a sizable proportion of this work has focused on the use of track-and-trigger tools and their predictive value in identifying patients most at risk of adverse outcomes (Downey, Tahir, Randell, Brown, & Jayne, 2017;Hands et al, 2013;Jarvis et al, 2015). Similarly, the interventions (primarily educational) proposed to address the problem of ALF have tended to focus on the behaviours related to patient monitoring and assessment (Liaw et al, 2016;Smith, Osgood, & Crane, 2002).…”

Section: Explanation For Level Of Specificity Scores Ofmentioning

confidence: 99%

How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

Smith

Sekhon

Francis

et al. 2019

Journal of Clinical Nursing

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Background To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an “afferent” and “efferent” limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust‐level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. Aim To identify how deteriorating patient policy documents provide “actionable” behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. Design A structured content analysis of a national guideline and local policies using a behaviour specification framework. Methods Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. Results There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). Conclusion Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. Relevance to clinical practice Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time‐sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.

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“…Additionally, while many studies have demonstrated the ability of EW/TTS to predict critical outcomes, the actual escalation of care process is rarely evaluated. 26 This "afferent limb" of when an alert will be triggered is greatly impacted by the performance of the track and trigger system in terms of sensitivity and also in terms of false positive or false alarm rate.…”

Section: Afferent Limbmentioning

confidence: 99%

“…20 Repetitive triggering, especially when automated, of an EWS without a true need for clinical escalation ultimately leads to alarm fatigue, desensitization, and disregard. 26 Jarvis and colleagues have recommended review and possible overhaul of the NEWS escalation protocol. 26 The authors demonstrated that NEWS values of 3 or 4 with a component score of 3 have significantly lower risks (odds ratio [OR]: 0.26 and 0.53) than an aggregate value of 5 (OR: 1.0).…”

Section: Afferent Limbmentioning

confidence: 99%

Early Warning/Track-and-Trigger Systems to Detect Deterioration and Improve Outcomes in Hospitalized Patients

Shiloh

Lominadze

Gong

et al. 2016

Semin Respir Crit Care Med

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As a global effort toward improving patient safety, a specific area of focus has been the early recognition and rapid intervention in deteriorating ward patients. This focus on "failure to rescue" has led to the construction of early warning/track-and-trigger systems. In this review article, we present a description of the data behind the creation and implementation of such systems, including multiple algorithms and strategies for deployment. Additionally, the strengths and weaknesses of the various systems and their evaluation in the literature are emphasized. Despite the limitations of the current literature, the potential benefit of these early warning/track-and-trigger systems to improve patient outcomes remains significant.

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Aggregate National Early Warning Score (NEWS) values are more important than high scores for a single vital signs parameter for discriminating the risk of adverse outcomes

Cited by 60 publications

References 17 publications

Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest, death or unanticipated intensive care unit admission?

Can binary early warning scores perform as well as standard early warning scores for discriminating a patient's risk of cardiac arrest, death or unanticipated intensive care unit admission?

How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

Early Warning/Track-and-Trigger Systems to Detect Deterioration and Improve Outcomes in Hospitalized Patients

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