The prognostic value of national early warning scores (NEWS) during transfer of care from community settings to hospital: A retrospective service evaluation

Journal article

Background:
The National Early Warning Score (NEWS) calculated from physiological observations provides a simple away to identify and respond to the deteriorating patient. There is increasing interest in the application of NEWS to facilitate referrals from the community.

Aim:
To establish whether elevated NEWS are associated with adverse outcomes at 5 and 30 days when obtained in a community setting at the time of transfer to an acute setting.

Design & Setting:
A retrospective service evaluation was undertaken using a database of emergency admissions to secondary care from two NHS district general hospitals within the South of England between January 2018 and April 2019.

Method:
The performance of NEWS recorded in a community setting to predict death or critical care admission at 5 and 30 days was calculated using established thresholds.

Results:
2786 referrals from primary care were analysed. The 5 day and 30 day mortality was 2.2% (1.7 to 2.8) and 7.1% (6.2 to 8.1). The prevalence of the composite outcome was 3.4% (2.8 to 4.2) at 5 days and 8.5% (7.5 to 9.6) at 30 days. The risk of adverse outcomes increased incrementally with increasing NEWS. When calculated at the point of referral from primary care the positive predictive value of death at 5 and 30 days was 15% (95% confidence intervals [CI] = 12 to 19) and 23% (95% CI = 17 to 30) in the high-risk NEWS group.

Conclusion:
Elevated NEWS obtained in the community during the process of emergency admission are associated with adverse outcomes. Communicating NEWS may allow downstream care to be better calibrated to risk.

Authors: Inada-Kim, M; Knight, T; Sullivan, M; Ainsworth-Smith, M; Pike, N

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Royal College of General Practitioners
• Journal: BJGP Open
• Volume: 4
• Issue: 2
• Article number: bjgpopen20X101071
• Publication date: 2020-06-23
• Acceptance date: 2020-03-23
• DOI: 10.3399/bjgpopen20x101071
• EISSN: 2398-3795
• Pmid: 32398345
• Language: English
• Keywords: continuity of care; patient safety; early warning score; secondary; hospitalization; hospital referrals; retrospective studies; FFR; primary health care; care; critical care