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.