A Royal College of Physicians (RCP) working party report has called for a national system for recognising very sick patients whose condition is deteriorating and who need more intensive medical or nursing care.
The working party has developed and piloted a National Early Warning Score (NEWS) for this purpose which, it says, if implemented across the NHS, would "result in a step-change upwards in patient safety," potentially saving 6,000 lives each year.Each acute hospital bed has a chart that is used to record measurements, such as the patient's pulse rate, blood pressure and temperature, which help the nursing and medical teams decide the severity of the patient's illness and if they need more urgent care.
However, at present NHS Trusts use different early-warning systems with different charts. As doctors and nurses move around different hospitals during their training and careers, they are not familiar with each Trust's system, and this results in a lack of consistency in detecting and responding to acutely-ill patients, says the RCP.
But having one NEWS with the same charts in every hospital would, says the report:
- provide the basis for a unified and systematic approach to both the first assessment of the patient and continuous tracking of their clinical condition throughout their stay, with a simple trigger for escalating the care;
- standardise the training of all staff engaged in the care of patients in hospitals in the NEWS system, so that staff should only need to be trained once instead of each time they move to a hospital that has a different system; and
- provide standardised data on regional variations in illness severity and resource requirements, as well as objective measurements of illness severity and clinical outcomes - an invaluable research resource.
NEWS 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 patient's care.
NEWS also has detailed recommendations on the actions for each score. For example, a medium score should prompt an urgent review by a clinician skilled with competencies in the assessment of acute illness - usually a ward-based doctor of acute team nurse, who should consider if a critical care outreach team is needed.The working party also points out that NEWS has been evaluated against many existing systems and found to be as good as the best of existing systems, and better than others. At the recommended trigger levels for a clinical alert, NEWS is also more sensitive than most existing systems, it adds.
The working party's chair, Professor Bryan Williams, pointed out that while many changes in health care are incremental, NEWS "has the potential to transform patient safety in our hospitals and improve patient outcomes. It is hugely important,” he said.
"Developing and adapting a standardised early-warning system will be one of the most significant developments in health care in the next decade," added Professor Derek Bell, chair of the NEWS educational subgroup, while Janet Davis, director of nursing and service delivery at the Royal College of Nursing (RCN), urged every NHS Trust to read the report “and adopt this system as soon as possible, as countless lives could be saved in the future by adopting this simple process."