Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England

Abstract

ObjectivesEarly warning scores were developed to improve recognition of clinical deterioration in acute hospital settings. In England, the National Early Warning Score (NEWS) is increasingly being recommended at a national level for use outside such settings. In 2015, the West of England Academic Health Science Network supported the roll-out of NEWS across a range of non-acute-hospital healthcare sectors. Research on the use of NEWS outside acute hospitals is limited. The objective of this study was to explore staff experiences of using NEWS in these new settings.DesignThematic analysis of qualitative semi-structured interviews with purposefully sampled healthcare staff.SettingWest of England healthcare settings where NEWS was being used outside acute hospitals—primary care, ambulance, referral management, community and mental health services.ParticipantsTwenty-five healthcare staff interviewed from primary care (9), ambulance (3), referral management/acute interface (5), community (4) and mental health services (3), and service commissioning (1).ResultsParticipants reported that NEWS could support clinical decision-making around escalation of care, and provide a clear means of communicating clinical acuity between clinicians and across different healthcare organisations. Challenges with implementing NEWS varied—in primary care, clinicians had to select patients for NEWS and adopt different methods of clinical assessment, whereas for paramedics it fitted well with usual clinical practice and was used for all patients. In community services and mental health, modifications were ‘needed’ to make the tool relevant to some patient populations.ConclusionsThis study demonstrated that while NEWS can work for staff outside acute hospital settings, the potential for routine clinical practice to accommodate NEWS in such settings varied. A tailored approach to implementation in different settings, incorporating guidance supported by further research on the use of NEWS with specific patient groups in community settings, may be beneficial, and enhance staff confidence in the tool.

Applying the Modified Early Warning Score (MEWS) to assess geriatric patients in home care settings: A qualitative study of nurses’ and general practitioners’ experiences

“…According to the participants in this study, MEWS has strengthened the collaboration and communication between health care personnel in general and RNs and GPs in particular. The present study supports findings from earlier studies in other contexts [20,23,26], in which the use of EWS systems to communicate objective findings improved communication between health professionals.…”

“…Several studies have highlighted challenges with using EWS systems in a variety of patient groups and pointed out the need to adjust EWS systems to ensure their proper use [20,[23][24][25]. In the present study, RNs and GPs reported that elderly patients in their habitual state frequently have vital sign values outside the MEWS reference values.…”

“…Early warning score systems in hospital and pre-hospital settings EWS systems, or physiological 'track-and-trigger' systems, were designed to support health care professionals in identifying and responding to acutely unwell patients at risk of clinical deterioration [20]. The effects of EWS systems have been thoroughly evaluated in hospital care settings.…”

“…Various scoring systems used in hospital settings perform well for predicting cardiac arrest and death within 48 hours [21][22][23]. Furthermore, studies show that EWS systems cannot replace clinical judgement, and EWS systems in combination with clinical judgement are important for making clinical decisions in pre-hospital and hospital settings [20,[24][25][26][27][28]. Several studies have noted the challenges of using EWS in a variety of clinical settings and patient groups and pointed out the need to adjust EWS approaches to ensure their proper use [20,[23][24][25].…”

“…Another study explored RNs' and GPs' experiences of using the UK's track-and-trigger National Early Warning Score (NEWS) system in pre-hospital, primary and community health care settings [20], with participants reporting that NEWS could support clinical decision-making around the escalation of care and could provide a clear means of clinical communication between clinicians and across different health care organisations. However, modifications were needed to make the tool relevant for certain patient populations in community services [20].…”