Are referrals to hospital from out-of-hours primary care associated with National Early Warning Scores?

Finnikin, Samuel; Hayward, Gail; Wilson, Fay; Lasserson, Daniel

doi:10.1136/emermed-2019-209069

Cited by 16 publications

(13 citation statements)

References 10 publications

(10 reference statements)

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“…This is similar to the observed time between symptom onset and COVID-19 death in other settings. 13, 14 Evidence for the role of NEWS in acute illness in community settings is growing, 15 16 17 18 19 but to date, only one descriptive study has provided empirical data on NEWS in care homes. 6 A recent systematic review on the use of NEWS in assessing unwell COVID-19 patients in primary care suggested that enthusiasm for its use may be premature.…”

Section: Discussionmentioning

confidence: 99%

National Early Warning Scores and COVID-19 deaths in care homes: a longitudinal ecological study

Stow

Barker

Matthews

et al. 2020

Preprint

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Objectives:To investigate whether patterns of National Early Warning Scores (NEWS/NEWS2) in care homes during the COVID pandemic correspond with area-level COVID-19 death registrations from care homes. Study design: Longitudinal ecological study. Setting: 460 Care home units using the same software package to collect data on residents, from 46 local authority areas in England. Participants: 6,464 care home residents with at least one NEWS recording. Exposure measure: 29,656 anonymised person-level NEWS from 29/12/2019 to 20/05/2020 with component physiological measures: systolic blood pressure, respiratory rate, pulse rate, temperature, and oxygen saturation. Baseline values for each measure calculated using 80th and 20th centile scores before March 2020. Outcome measure: Time series comparison with Office for National Statistics (ONS) weekly reported registered deaths of care home residents where COVID-19 was the underlying cause of death, and all other deaths (excluding COVID-19) up to 10/05/2020. Results: Deaths due to COVID-19 were registered from 23/03/2020 in the study geographical areas. Between 23/03/2020 and 10/05/2020, there were 5,753 deaths (1,532 involving COVID-19 and 4,221 other causes). The proportion of above-baseline NEWS increased from 16/03/2020 and closely followed the rise and fall in COVID-19 deaths over the study period. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in care home deaths in corresponding geographical areas. Conclusions: NEWS may make a useful contribution to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as total NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents' health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

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Section: Discussionmentioning

confidence: 99%

National Early Warning Scores and COVID-19 deaths in care homes: a longitudinal ecological study

Stow

Barker

Matthews

et al. 2020

Preprint

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“…Referrals to secondary care were identi ed from the recorded consultation outcome using methods previously described. (11)…”

Section: Discussionmentioning

confidence: 99%

Assessment and referral in suspected COVID-19: a community based observational study

Finnikin

Haroon

Cooper

et al. 2021

Preprint

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Background The COVID-19 pandemic presented new diagnostic and management challenges to primary care alongside rapid changes in service delivery. The purpose of this study was to describe the characteristics of patients with symptoms of COVID-19 in primary care, explore which characteristics were associated with a clinical diagnosis of COVID-19 and referrals to secondary care, and to describe secondary care referral decisions with reference to national guidance. Methods An observational study using routinely collected data from the Birmingham Out-of-hours Research Database. The study uses consultation data from the Birmingham and Solihull COVID Referral Centre (CRC) between 21st April and 24th July. All CRC consultations were examined to extract patient demographics, free text consultations, prescriptions, observation and onward referrals. The National Early Warning Score (NEWS2) was calculated and the clinical diagnosis of COVID-19 was established. The population was described and univariate logistic regression was used to identify characteristics associated with clinical diagnosis of COVID-19 and referral decisions. Results 681 patients were seen at the CRC and 56.3% were identified to have a clinical diagnosis of COVID-19. 14.0% of all patients were referred to secondary care, but 59% of patients classified as most severe according to national criteria were not referred. Referral was associated with increasing age, shortness of breath, tachycardia, tachypnoea and hypoxia but patients with a clinical COVID-19 diagnosis were less likely to be referred than those with other diagnoses. Conclusion Just over half of patients seen in the CRC were clinically diagnosed with COVID-19 and most patients were managed in the community. Guidelines developed in the absence of service delivery data for the management of COVID-19 were inconsistent with community urgent care delivery.

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“…A recent study of an out-of-hours primary care service calculated NEWS retrospectively from physiological variables obtained at the time of assessment. 17 The individual physiological observations were known to the clinician, but not summarised as an aggregate score. NEWS was a poor predictor of whether an individual patient was subsequently referred acutely to secondary care.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

The prognostic value of national early warning scores (NEWS) during transfer of care from community settings to hospital: a retrospective service evaluation

et al. 2020

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BackgroundThe National Early Warning Score (NEWS) calculated from physiological observations provides a simple away to identify and respond to the deteriorating patient. There is increasing interest in the application of NEWS to facilitate referrals from the community.AimTo establish whether elevated NEWS are associated with adverse outcomes at 5 and 30 days when obtained in a community setting at the time of transfer to an acute setting.Design & settingA retrospective service evaluation was undertaken using a database of emergency admissions to secondary care from two NHS district general hospitals within the South of England between January 2018 and April 2019.MethodThe performance of NEWS recorded in a community setting to predict death or critical care admission at 5 and 30 days was calculated using established thresholds.Results2786 referrals from primary care were analysed. The 5 day and 30 day mortality was 2.2% (1.7 to 2.8) and 7.1% (6.2 to 8.1). The prevalence of the composite outcome was 3.4% (2.8 to 4.2) at 5 days and 8.5% (7.5 to 9.6) at 30 days. The risk of adverse outcomes increased incrementally with increasing NEWS. When calculated at the point of referral from primary care the positive predictive value of death at 5 and 30 days was 15% (95% confidence intervals [CI] = 12 to 19) and 23% (95% CI = 17 to 30) in the high-risk NEWS group.ConclusionElevated NEWS obtained in the community during the process of emergency admission are associated with adverse outcomes. Communicating NEWS may allow downstream care to be better calibrated to risk.

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Are referrals to hospital from out-of-hours primary care associated with National Early Warning Scores?

Cited by 16 publications

References 10 publications

National Early Warning Scores and COVID-19 deaths in care homes: a longitudinal ecological study

National Early Warning Scores and COVID-19 deaths in care homes: a longitudinal ecological study

Assessment and referral in suspected COVID-19: a community based observational study

The prognostic value of national early warning scores (NEWS) during transfer of care from community settings to hospital: a retrospective service evaluation

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