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Warning score system for patient deterioration due to be standard across NHS by 2019

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Every NHS hospital in England will be expected to use the same clinical assessment scoring system to spot patient deterioration by 2019 to ensure staff do not speak at “cross purposes”, healthcare bosses have said.

The national early warning score (NEWS) system involves measuring breathing, blood pressure, temperature, level of consciousness and oxygen saturation, and recording a combined high, medium or low rating on a chart.

“I want to see every hospital in the country using the NEWS approach by 2019”

Bruce Keogh

A low score of between one to four would prompt an assessment by a registered nurse, a medium score of between five to six would lead to an urgent review from an acute clinician, such as a ward-based doctor, and a high score of seven or more would see an emergency assessment by a critical care team.

The system, launched by the Royal College of Physicians in 2012, is already in use in around 70% of NHS trusts in the country. It has also been endorsed in Scotland and Wales.

But it is now being backed in England by regulator NHS Improvement and NHS England, with staff in all acute and ambulance services expected to be using it by 2019.



Bruce Keogh

The aim is to ensure NHS staff who move between different trusts use a consistent set of measures to diagnose patients. It is believed up to 2,000 lives every year could be saved as a result.

NHS England national medical director Sir Bruce Keogh said: “If staff move between hospitals and end up speaking at cross-purposes, warning signs are missed and patient care can be compromised.

“I want to see every hospital in the country using the NEWS approach by 2019 as we continually strive to make sure the NHS delivers the highest standards of care possible.”

Meanwhile, the college said NEWS had already been adopted by hospitals across the world.

Since launching it in 2012, the system has been updated (see below, attached) to include a new section on the chart for scoring oxygen saturation for patients with hypercapnic respiratory failure, said the organisation.

This version, known as NEWS2 and being endorsed today by the NHS, has also been developed to recognise delirium as a sign of potentially important clinical deterioration, and emphasises how the system can be used to help identify sepsis, added the RCP.

“The uptake and impact of the NEWS over the past five years has been extraordinary”

Bryan Williams

Professor Bryan Williams, chair of the NEWS development group, said: “We developed the NEWS to save lives in the NHS. The uptake and impact of the NEWS over the past five years has been extraordinary, and beyond even the most optimistic expectations, especially considering that there was no national incentive or directive to implement it.”

“The majority of NHS hospitals are now using the NEWS, and over 150,000 NHS staff have voluntarily completed the online NEWS training and accreditation programme,” he said.

“As we move into 2018, I am delighted that we have the endorsement of NHS England and NHS Improvement in implementing NEWS2 across the NHS in England,” he added.

A working group to oversee the introduction of the scoring sytstem will be chaired by Celia Ingham Clark, consultant surgeon and NHS England’s medical director for clinical effectiveness. 

How NEWS2 works

NEWS2 is based on a simple scoring system in which a score is allocated to six physiological measurements already taken in hospitals – respiratory rate, oxygen saturations, temperature, systolic blood pressure, pulse rate and level of consciousness.

A score is allocated to each measurement. The more the measurements vary from what would have been expected (either higher or lower), the higher the score. The six scores are then aggregated to produce an overall score which, if high, will alert the nursing or medical team of the need to escalate the care of the patient.

NEWS also has detailed recommendations on the actions for each score. For example, a medium score should prompt an urgent review by a clinical skilled with competencies in the assessment of acute illness – usually a ward-based doctor or acute team nurse, who should consider if a critical care outreach team is needed.


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