A retrospective observational study to explore the introduction of the National Early Warning Score in NEAS
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Abstract
Abstract published with permission.
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.