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A retrospective observational study to explore the introduction of the National Early Warning Score in NEAS

02 February 2015
Features
02 February 2015
Volume 7 · Issue 2

Abstract

Background:

The National Early Warning Score (NEWS) is a simple, rapid assessment tool compiled from respiratory rate, oxygen saturations, supplemental oxygen, temperature, systolic blood pressure, heart rate and level of consciousness developed by the Royal College of Physicians. NEWS was introduced into practice at North East Ambulance Service NHS Foundation Trust (NEAS) between April 2013 and March 2014. This paper will examine the use of NEWS in pre-hospital practice and seek to describe the patient population in terms of NEWS.

Methods:

Cross-sectional samples of patient records from NEAS attendances over two 24-hour periods were examined for NEWS usage, completeness of necessary observations and outcomes that may be linked to NEWS. A primary sample from 8 July 2013 included 100% of patients. A secondary sample of 10% of patients was taken from 1 April 2014.

Results:

Although 90% of all cases may be suitable for NEWS <1% (n=6) of patients attended had NEWS recorded. Of the NEWS elements only temperature was not consistently recorded. 95% of sets of observations included >4 NEWS elements. A consistent pattern emerged when the sample population was described according to NEWS using three methods of accounting for missing items of data. Pre-alerting based on NEWS was examined with little agreement between NEWS and current practice found, although this does not take into account practical reasons for pre-alerting such as underlying condition or local pathways.

Conclusions:

NEWS is not being documented by ambulance crews although the majority of the necessary elements are being recorded. This largely descriptive account of the use of NEWS within NEAS indicates that NEWS has not been adopted by ambulance crews.

The National Early Warning Score (NEWS) is a simple, rapid assessment tool developed by the Royal College of Physicians (RCP) (2012) to standardise the assessment and monitoring of patients presenting with acute illness. NEWS scores six physiological observations from 0–3 and adds a weighting of two points for the use of supplemental oxygen. The scores are combined to give an indication of the patient's wellbeing (see Appendix 1 for the NEWS tool). NEWS is not suitable for maternity cases or paediatric patients due to their altered physiological norms.

This study will investigate the introduction of NEWS into pre-hospital practice by North East Ambulance Service NHS Foundation Trust (NEAS). NEAS introduced NEWS to support paramedic decision making and to ease communication with other health professionals. NEAS introduced NEWS through the Essential Annual Training (EAT) programme (April 2013 to March 2014). EAT is an annual two-day update for all NEAS staff and NEWS was one element that was covered in around one hour of teaching and discussion. There is a lack of literature describing the use of NEWS in the pre-hospital setting so this study will seek to address this gap and give an insight into how this patient assessment system has been adopted and used by staff.

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● National early warning score
● Observations
● Pilot study
● Pre-alert