The Deterioriating Patient: Let the numbers do the talking

The Deteriorating Patient:
Let the numbers do the talking
Thursday 16 March 2017
#wesharethenews

Welcome & Introduction
Anne Pullyblank, West of England AHSN
#wesharethenews

NEWS in practice
After treatment
16:30
GP
16:59
Ambulance
ePCR
17:55
ED Triage
18:55 19:15 19:50 21:00
18:19
ED Treatment:
Antibiotics & Fluids
Film Premier

Year 1
• Focus on introducing NEWS to all settings and
using NEWS accurately
• Some acute organisations had EWS so
changed to NEWS

Bristol GPs
North Somerset GPs
South Gloucestershire GPs
BaNES GPs
Wiltshire GPs
Swindon GPs
Gloucestershire GPs
University Hospitals Bristol NHS
FT
North Bristol NHS Trust
Weston Area Health Trust
Gloucestershire Hospitals
Great Western Hospital
Royal United Hospital
Bristol Community Health
Sirona Care & HealthNorth Somerset Community
Partnership
Gloucestershire Care Services
Wiltshire Care & Health
Community Services
SPCA - Bristol Community
Health
SPCA - Gloucestershire Care
Services
SPCA - Medvivo
Brisdoc
SWASFT (Out of Hours)
Medvivo
Great Western Hospital (Out of
Hours)
BaNES Doctors Urgent Care
AWP
2gether NHS FT
SWAST
Primary Care
Acute Trusts
Community Services
Single Point of
Access
GP Out of
Hours
Mental Health
March 2015

Bristol GPs
North Somerset GPs
BaNES GPs
Wiltshire GPs
Swindon GPs
Gloucestershire GPs
FT
Partnership
Community Services
Health
Services
SPCA - Medvivo
Brisdoc
Medvivo
Hours)
AWP
2gether NHS FT
SWAST
Primary Care
Acute Trusts
Community Services
Single Point of
Access
GP Out of
Hours
Mental Health
March 2016

Bristol GPs
North Somerset GPs
BaNES GPs
Wiltshire GPs
Swindon GPs
Gloucestershire GPs
FT
Partnership
Community Services
Health
Services
SPCA - Medvivo
Brisdoc
Medvivo
Hours)
AWP
2gether NHS FT
SWAST
Primary Care
Acute Trusts
Community Services
Single Point of
Access
GP Out of
Hours
Mental Health
March 2017

Year 2
Focus on using NEWS at handover of care

Bristol GPs
North Somerset GPs
BaNES GPs
Wiltshire GPs
Swindon GPs
Gloucestershire GPs
FT
Partnership
Community Services
Health
Services
SPCA - Medvivo
Brisdoc
Medvivo
Hours)
AWP
2gether NHS FT
SWAST
Primary Care
Acute Trusts
Community Services
Single Point of
Access
GP Out of
Hours
Mental Health

By September 2018, improve recognition
of the deteriorating patient resulting in:
20% reduction in mortality from sepsis
(ICD-10 codes A40/41)
30% reduction in in-hospital cardiac arrests
outside of ITU and CCU
50% reduction in transfers to ICU due to in-
hospital deterioration, or wrong
placement, within 24 hours of ED
admission
Improved assessment /monitoring of
patients condition within settings
Patients to have accurate NEWScore
whilst inpatients, including in all
urgent care settings
Patients to have an accurate
NEWScore calculated at emergency
contact by community staff
Emergency GP referrals (of
appropriate adults) to have an
accurate full set of observations and
NEWScore
Improved communication of
NEWScore on transfer between
settings
NEWScore communicated at point
of referral and arrival in secondary
care
Patients to have a NEWScore at
transfer of care outside critical care
settings
*Use of structured communication
Improved response to deteriorating
patients within settings.
Patients with a NEWScore of >=5 to
have a rapid assessment according
to the local escalation plan by an
appropriate team
**Patients with NEWScore >=5 to
have screening for sepsis and
application of sepsis six within one
hour of triggering
Patients, families and carers involved
in decisions and planning of care
Use of Treatment Escalation Plan
(TEP) in emergency admissions to
secondary care

First session
Cannot present everything!
Improved
assessment
/monitoring of
patients condition
within settings
Improved response
to deteriorating
patients within
settings.

Improved
communication of
NEWScore on
transfer between
settings

Workshops
• Secondary care
• Community and
primary care
• Community and
mental health
inpatient
• Successes
• Challenges
• Enablers
• Sharing ideas

What Does Success Look Like?
• Qualitative data
• Microsystem – Outcome data
• NIHR CLAHRC West
– National Institute for Health Research
Collaboration for Leadership in Applied Health
Research and Care West

Standardised electronic patient record templates
Enablers

Electronic Observation Systems
• Demonstrations during lunch break
• Q&A Session 2pm – Abbey Suite (1st Floor)
Enablers

Update on process measures
from across the region
#wesharethenews

By September 2018, improve recognition
of the deteriorating patient resulting in:
20% reduction in mortality from sepsis
(ICD-10 codes A40/41)
30% reduction in in-hospital cardiac
arrests outside of ITU and CCU
50% reduction in transfers to ICU due to
in-hospital deterioration, or wrong
placement, within 24 hours of ED
admission
Improved assessment /monitoring
of patients condition within settings
Patients to have accurate
NEWScore whilst inpatients,
including in all urgent care settings
NEWScore calculated at emergency
contact by community staff
Emergency GP referrals (of
appropriate adults) to have an
accurate full set of observations
and NEWScore
settings
NEWScore communicated at point
of referral and arrival in secondary
care
Patients to have a NEWScore at
transfer of care outside critical care
settings
*Use of structured communication
patients within settings.
Patients with a NEWScore of >=5 to
have a rapid assessment according
to the local escalation plan by an
appropriate team
**Patients with NEWScore >=5 to
have screening for sepsis and
application of sepsis six within one
hour of triggering
Patients, families and carers
involved in decisions and planning
of care
Use of Treatment Escalation Plan
(TEP) in emergency admissions to
secondary care

Process Measures
By September 2018, improve recognition of
the deteriorating patient resulting in:
20% reduction in mortality from sepsis (ICD-
10 codes A40/41)
hospital deterioration, or wrong placement,
within 24 hours of ED admission
Improved assessment /monitoring
of patients condition within
settings
Improved response to
deteriorating patients within
settings.

University Hospitals Bristol
NEWS update
March 2017
Anne Reader, Head of Quality (Patient Safety)

Improved Assessment/Monitoring of
patients’ condition in an acute hospital
• Data is collected via a monthly point prevalence audit ≈ 650 adult in-
patients a month
• The measure is observations completed and NEWS correctly
calculated
NEWS
implemented

patients’ condition in an acute hospital ED
• Data is collected via a monthly audit of 50 ED patients a month

patients’ condition in an acute hospital ED

Challenges:
• Sustaining manual observations once a day on
general in-patient wards
• Ensuring staff manual observations competency
assessments are up to date
• Crowding in adult ED and flow pressures,
particularly for NEWS recording

Successes:
• Sustained improvement of ≈ 99% for in-patients
• Improvement of hourly NEWS in ED but not yet
sustained
• No incidents of failure to recognise deterioration in
ED this winter despite worst operational pressures
to date

Future work:
• Integration of coloured NEWS chart in ED
admission proforma, just finalised
• Paediatric ED interested in using checklist concept
• Further education and culture development around
manual observations on general wards

patient within an acute hospital
• Data is collected via a monthly point prevalence
audit ≈ 650 adult in-patients a month
• The measure is documented response in line with
escalation protocol for a NEWS of 5 or more or 3
in one parameter

NEWS
charts
launched
Trust wide teaching.
Increase in the
number of patients
needing a doctor
review
NEWS
magnets for at
a glance board Test of using fast bleep to
improve response times to
elevated NEWS.
NEWS now being used in
ED
Frequency of
observations for
a NEWS score of
1-4 changed in
response to
feedback
NEWS E-
learning now
available
Test of using
baton bleep to
improve
response times
to elevated
NEWS.
Safety brief on
reporting
NEWS
incidents on
datix
New
escalation
poster
Frequency of
observations
box now on
2 pages and
example of
resetting
triggers on
chart

Challenges:
• Mainly occur in out of hours provision
• Confidence of some more junior RNs to escalate to
ST3/ consultant
• Ability of more senior doctors in some in-patient
specialties to respond
• Resetting the triggers for appropriate patients
• Impact of end of life care planning in primary care

Successes:
• Starting to see reduction in variation ≈90-94%
• NEWS on ED arrival via ambulance and starting to
see NEWS in some GP referrals

Future work at UH Bristol:
• Finalise 1:1 debriefs of staff involved in NEWS
incidents, further learning?
• Address out of hours rota amendments for
responders
• Look at alternative responders ?further CSM out of
hours Surgery and Specialised Services
• NEWS credit card distribution

Future work at UH Bristol:
• SBAR focus group doctors and nurses ? Need to
simplify/amend
• ?rename resuscitation team ?cultural reluctance to
call peri-arrest
• Complete testing of ward round check list inc.
NEWS review

Future work with WEAHSN partners for
consideration:
• With support, we are keen to lead standardised PEWS1 across
WEAHSN and SWAHSN
• Agreed in principle across South West Paediatric Critical Care network
to take forward
• Some providers already using same PEWS
• Ireland and Scotland have launched their national (but different) PEWS
• Making it Safer Together (MIST) paediatric patient safety collaborative
are encouraging regional unity in the absence foa longer term England
PEW tool
• New Associate Professor for Children’s Nursing at UWE specific interest
in deteriorating child
1Haines C, Perrot M and Weir P (2005) Promoting care for the acutely ill children- Development and evaluation of a Paediatric
Early Warning Tool Intensive and Critical Care Nursing. vol 22 issue 2 p73-81.

Lorraine Motuel
Vardeep Deogan
The Deteriorating
Patient
-let the numbers do the
talking

Working together for Patient Safety
One single NEWS vital signs chart for two Bristol hospitals
The Pledge
After the launch of the WEAHSN National Warning Score event in March 2015 the two acute Bristol
hospitals have been working together to develop, test and implement a single, shared vital signs
NEWS chart across both hospitals.
In 2008 as part of SPI2 both hospital s developed a EWS chart for vital signs. Over the years the 2 charts have been
modified considerably and are now very different (see above)
• Ambitious project bringing in
NEWS and Pain assessment and
Sepsis screen prompting in a
single chart
• Fantastic collaboration with
Sepsis teams, Pain teams and
Safety leads from both hospitals
• New chart ready to be tested on
a wider scale by end of this
month with Go Live planned in
November 2015
• We’re all still friends 
NEWS and Sepsis
responder sticker PDSA#1

NEWS chart
implemented trust
wide

NBT’s Quality Indicator Audit

Assessment and Treatment of the
Deteriorating Patient

Aim/Outcome Primary Drivers Secondary Drivers
Reduce
avoidable
in-hospital
cardiac
arrests by
10% each
year by
April 2018
Reliable early recognition of
the deteriorating patient
Reliable communication,
referral and escalation
Appropriate response
Adopt one EWS - NEWS
Escalation procedures / TEP
24/7 Critical Care Outreach service
Mandatory training tracker
Minimum standard of training
Sphygmomanometers/stethoscopes in
clinical areas
Appropriate number of monitored beds
Electronic data collection system
Measures
Outcome:
Total number of in
hospital cardiac arrests
Rate of in hospital
cardiac arrests per 1000
bed days
Process measures:
% of patients with a
completed NEWS score
for last 5 sets of Obs
% of patients with an
accurate NEWS score for
last 5 sets of Obs
% of triggered patients
receiving an appropriate
response (escalation)
% of triggered patients
with a documented care
management plan
Sign Up to Safety - Deteriorating Patient
Deteriorating patient policy
Training on use of SBAR
Simulation training - TWIST

Successes
Trust wide NEWS – Percentage of
observations with NEWS
calculated
Trust wide NEWS – Percentage
of observations with NEWS
calculated correctly every
time

Example – Impact of simulation
training on one ward area (TWIST)
Other Trust wide initiatives,
Mandatory training tracker / 2 x videos / ward based champions / attending
ward meetings & study days / monthly working group meetings

patient within the acute hospital
• Methodology – promoting use of SBAR / hand over,
targeting Dr teaching (involving TWIST), 24/7 Critical Care
Outreach launched in January ‘17

Improved Assessment / Monitoring
and Response to the Deteriorating Patient
 Challenges –
 how to be creative with limited resources
 engaging Drs and the MDT
 empowering staff to value the change
 Successes – making good progress
 Future work –
 E observations (Jan 2018?)
 on-going training
 amalgamation with Swindon

NEWS Update : Royal United Hospital Bath
Anne Plaskitt, Senior Nurse Quality Improvement

Monitoring of NEWS
 Quarterly audit of NEWS recorded within an
hour of admission - 50 patients admitted to ED
or direct to MAU,SAU and ASU
 Monthly audit on all adult wards and ED : 10
vital signs charts last 5 sets of observations

Ward level data
Number of Cascade trainers = 3
Number of staff trained at level 2 by Cascade trainers = 47 : 91% of nursing staff

Trustwide compliance NEWS recorded

Trustwide compliance NEWS accuracy

ED Data : NEWS recorded and accuracy
First round of
improvements
commenced
2nd May
Second round
of training
commenced
18th July
90% staff trained
in level 2
Sept 2106 95% staff
trained in
level 2
Feb 2017

Next steps assessment and response to deterioration
Challenges – Achieving accuracy of NEWS
Successes – Cascade trainers and simulation model of training
Next steps
 Revised format of NEWS chart and Escalation Sticker : launch
April 2017
 Decrease common errors with NEWS
 Improve escalation process
 Include Sepsis screening
 Develop ‘Deteriorating Patient’ training combining NEWS, Sepsis and AKI
 Implementation electronic observations – investigating systems
 Significantly improve accuracy
 Improve escalation
 Sepsis screening simple and automatically recorded
 Easily available information for all patients to support improvement work

Gloucestershire Hospitals NHS
Foundation Trust
Ben King
Lead for Acute Care Response Team, Resuscitation and
Simulation

Monitoring of patients condition within
ED
• Study of all cardiac arrests on general wards in 1
year showed NEWS on admission averaged 3.5
– Low score in ED still has potential to deteriorate
– Mean age of these patients 79
• Those with raised NEWS in ED are triaged more
quickly but trolley waits remain a problem
• 2222 calls to ED account for only 14% of calls
across Trust (even when pre-hospital events are
excluded)

Deteriorating patients excluding ED
• Record
– 26% compliance with NEWS frequency
– 11% incorrectly calculated
• Recognise
– 35% had documented recognition of problem (others may
have recognised but not documented it)
• Report
– Next slide shows staff willing to report even if score is low
– There is anecdotal evidence of staff unclear as to who to
escalate to (days / nights weekends etc)

0
5
10
15
20
25
30
35
40
NEWS
0-2
NEWS
3-5
NEWS
6-7
NEWS
8-9
NEWS
10-12
NEWS
13+
Concern (% of calls)
Raised NEWS (% of calls)
Observations:
Chart states “Score 1 – 4
consider calling ACRT”, in
practice almost 50%
referrals had score 5 or less
Almost all calls for ‘Raised
NEWS’ were 6 or greater –
likely due to co-morbidities
in in-patients causing a
permanently raised NEWS
score
Over 30% of calls for raised
NEWS were for scores for
10 or more (suggesting a
late call)
Reasons for calling Acute Care
Response Team (ACRT)
‘Concern’ vs ‘Raised NEWS’

0
20
40
60
80
100
120
140
160
180
GRH
CGH
Observations:
• ACRT is frequently called to
review patients who are not
for CPR
• Many patients seen by the
ACRT do not have an
escalation plan in place and
therefore one is requested by
them
Cat 1 – For all interventions
Cat 2 – Not for CPR but all care
Cat 3 – Not for CPR or ITU but
all other care
Cat 4 – All treatment is aimed at
patient comfort
Referral to the Acute Care Response
Team for either ‘Concern’ or ‘Raised
NEWS’

Changing NEWS Policy
• Record – re-educate staff of importance / improve compliance
• Recognise – highlight common errors
• Report
– Any score of 5 or more is reported to ACRT (ie not Medical
Staff) – likely to increase workload (but not excessively)
– Will mean all scores of 5 will be known
– Will ensure accurate audit if there is a single point of access
• Respond
– Aim for a more rapid response by ACRT
– Aim for closer collaboration between ACRT and Medical
Teams

Measuring NEWS in AWP
Sarah Harding, Practice Development Nurse (NEWS Lead)
sarah.harding10@nhs.net
Peter Dixon, Clinical Audit & Improvement Facilitator
peter.dixon10@nhs.net

NEWS in AWP
40
WARDS
563
BEDS
650
AUDITED
46.7%
NEWS 1 - 4
2.8%
NEWS 5+
8.3%
DECLINE

Challenges
Size and Resource
Declining (Refusing)
NEWS
Clinical Response to
lower scores
Re-setting trigger
thresholds
Medical Leadership
Successes
Raising Profile
Non-Contact
PHO
Procedural
Guidance &
Training
Pre-Registration
Education
Future Plans
Local Ownership
NEWS in CMHT
Non-Contact PHO: V2
Clinical Response / Care
Planning re-set trigger
thresholds
Training for medical
colleagues
NEWS at point of
transfer
Measuring impact of
NEWS on Clinical
Outcome

Process Measure
By September 2018, improve recognition of
the deteriorating patient resulting in:
20% reduction in mortality from sepsis (ICD-
10 codes A40/41)
hospital deterioration, or wrong placement,
within 24 hours of ED admission
settings

NEWS and the Ambulance Service
Adrian South, Deputy Clinical Director

Population of 5.3 million
Annual influx +17.5 million
tourists

• ECS is bigger than ePCR
• Decision support
• Spine connectivity (useful if primary care
baseline)
• NHS Number capture
• Systems integration
• Live vital signs telemetry
• Data capture
Wider Benefits of ECS

Total ECS
Records
Created
ECS with
NEWS
Recorded
% ECS with
NEWS
Recorded
Conveyed 335,207 207,286 61.8%
Non-
conveyed
230,425 139,964 60.7%
All ECS records for the period 01/04/16 – 28/02/17

0
5000
10000
15000
20000
25000
30000
35000
40000
45000
Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb
2016 2017
NEWS Score Completion Over Time (n)

59.0
60.0
61.0
62.0
63.0
64.0
65.0
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb
NEWS Score Completion Over Time (%)

ECS records for the period 01 Apr 16 - 28 Feb 17
Low Risk
(f)
nZero
(g)
n1-4
(h)
f+g
Low risk
(i)
h/b
Low as %
of all
NEWS
(j)
n5-6
Med risk
conveyed 46631 111320 157951 76.2% 24297
non-conveyed 52691 77462 130153 93.0% 6593
Total 99322 188782 288104 83.0% 30890
(f)
nZero
(g)
n1-4
(h)
f+g
Low risk
(i)
h/b
Low as %
of all
NEWS
(j)
n5-6
Med risk
conveyed 46631 111320 157951 76.2% 24297
non-conveyed 52691 77462 130153 93.0% 6593
Total 99322 188782 288104 83.0% 30890

Medium Risk
(f)
nZero
(g)
n1-4
(h)
f+g
Low risk
(i)
h/b
Low as %
of all
NEWS
conveyed 46631 111320 157951 76.2%
non-conveyed 52691 77462 130153 93.0%
Total 99322 188782 288104 83.0%
(f)
nZero
(g)
n1-4
(h)
f+g
Low risk
(i)
h/b
Low as %
of all
NEWS
(j)
n5-6
Med risk
(k)
j/b
Med as %
of all
NEWS
(l)
n7plus
High risk
(m)
l/b
High as %
of all
NEWS
46631 111320 157951 76.2% 24297 11.7% 25038 12.1%
52691 77462 130153 93.0% 6593 4.7% 3218 2.3%
99322 188782 288104 83.0% 30890 8.9% 28256 8.1%

High Risk
(f)
nZero
(g)
n1-4
(h)
f+g
Low risk
(i)
h/b
Low as %
of all
NEWS
conveyed 46631 111320 157951 76.2%
non-conveyed 52691 77462 130153 93.0%
Total 99322 188782 288104 83.0%
(h)
f+g
ow risk
(i)
h/b
Low as %
of all
NEWS
(j)
n5-6
Med risk
(k)
j/b
Med as %
of all
NEWS
(l)
n7plus
High risk
(m)
l/b
High as %
of all
NEWS
157951 76.2% 24297 11.7% 25038 12.1%
130153 93.0% 6593 4.7% 3218 2.3%
288104 83.0% 30890 8.9% 28256 8.1%

• NEWS is now far more prominent on the hospital
workstation screen
• Support for clinical handover and patient prioritisation
• Part of NQP validation functionality
• Utilisation of NEWS to support organisational learning
• Will be introduced as part of the new HCP process.
• Audit and QI event to explore non-conveyed high
NEWS
The Journey Continues

Patient Care Workforce Care Quality Care Resource Care
OOH NEWS
Dr Chris Dykes

Referrals from:
NHS 111
• pathways assessment
• clinical advisors
Professional line (0117 244 9283)
• SWAST clinical desk
• Paramedics on scene
• District nursing/ Rapid response
• Pathology labs
• GP’s within OOH service for follow up of cases
• GP’s in-hours

Admission Manage in the Community
NHS111 Professional Line
Clinical Coordinator
Clinical Advice (telephone
assessment)
Face to face appointments
Home Visiting
Referrals to: Usual GP
District Nursing/ RR
Mental Health teams
Referrals to: Acute trusts
SWAST/ 999

Priorities:
Adult/ Surgical acute admissions
Other uses:
Identification of severe illness/ deterioration
Common language
Encouraging complete sets of observations

Hurdles:
• Training
• Large workforce
• Urgent care setting/ vs routine work
• NEWS not always helpful in acute assessment
• High baseline NEWS can be misleading (COPD)
• Accessibility of calculator
• Adastra
• Lack of familiarity
Methodology:
• Adastra case closure
• Admitted?
• News completed?
• Training/ Sharing
• Inductions

Posters:
Inductions:

April May June July August September October November december Jan
Admissions
Number 181 210 192 176 144 142 154 142 163 151
If Admitted ?
NEWS score 57 81 76 79 72 45 71 60 80 80
DATA:

20
25
30
35
40
45
50
55
April May June July August September October November december Jan
% NEWS completed- for adult admissions
% NEWS completed

Areas for development:
• EMIS write
• Exploration and learning of the use of NEWS
• Sharing the learning, feedback to clinicians
• Accessibility of NEWS cards
• Data transfer between services
• Call handler training

NEWS Training
Dr Clare Kelly

What is NEWS?
Who thinks NEWS is a good idea?
How does NEWS help the patient?
Are there any times when I cannot use NEWS?
Are there any problems with NEWS?
How do I calculate a NEWScore?
What does the NEWScore mean?
NEWS score
please

NEWS FAQs
- can a computer/app calculate the score for me?
- What if I get the score wrong?
- What if the obs are incomplete?
- What if the referring clinician says “obs normal”?
- What if they refuse to give me the obs?
- GPs don’t seem to like NEWS, why?!
How can I improve and check my NEWS learning?
https://tfinews.ocbmedia.com/

Using National Early Warning
Scores in Pre-Hospital Settings: an
Evaluation
Jon Banks PhD & Niamh Redmond PhD
Research Fellows
NIHR CLAHRC West
University Hospitals Bristol NHS Foundation
Trust, Bristol

CLAHRC West
NIHR CLAHRC West
National Institute for Health Research
Collaboration for Leadership in Applied Health Research
and Care West
• A collaborative partnership between universities and
surrounding NHS, local authorities and social care organisations
• Draw practice and research closer together, to provide
evidence-based care for users of services within the NHS and
social care

CLAHRC West
A – Gloucestershire
B – South Gloucestershire
C – Bristol
D – North Somerset
E – Bath and North East Somerset
F – Wiltshire
G – Swindon

CLAHRC West
Research and implementation themes
Chronic health
conditions
Equity,
appropriateness
and
sustainability
Mental Health
Public and
population
health

CLAHRC West
Evaluating NEWS
Collaboration
WEAHSN
Introduction of
NEWS across
the region
CLAHRC
Evaluation of
NEWS across
the region

CLAHRC West
Evaluating NEWS
Why evaluate NEWS?
• NEWS – A new tool for patient safety
• CLAHRC – Interested in health care
innovation & patient safety

CLAHRC West
The Rationale for NEWS
• Developed by Royal College of
physicians
– A standardised assessment of
the acutely-ill patient
– A standardised response by
clinical staff to the acutely-ill
patient
– A standardised language to
communicate about the acutely ill
patient

CLAHRC West
Evaluating NEWS
Why evaluate NEWS?
Royal College of Physicians
• Uncertainty about how an EWS should be validated
• Recognition that robust research needed
• Adoption of a standardised NEWS would help
facilitate and inform such research

CLAHRC West
Evaluating NEWS
• Systematic Review
– Examine existing
evidence
• Qualitative study
– How is NEWS
used?
• Quantitative study
– How to evaluate
NEWS using
quantitative data?

CLAHRC West
Evaluating NEWS
Systematic Reviews EWS
– Existing research and
evidence on early warning
scores
– (a) In hospital
– (b) In pre-hospital
Progress
(a) Identified ~10 reviews
(b) Identified 10 studies
Analysis started

CLAHRC West
• NEWS  A simple tool to use
But
• NEWS  A complex tool to use
Qualitative research
Has to communicate
across a range of
people/organisations
Has to be recognised
as clinically useful by
those who use it
Has to trigger a
response by
clinicians and health
care organisations
We can capture these aspects of NEWS by talking
to people about their experience of using the tool

CLAHRC West
News in the pre-hospital
Royal College of Physicians
• Focused on using NEWS in
hospital
WEAHSN
• NEWS in pre-hospital

CLAHRC West
Qualitative study
• Interviews, Dec 2016 – April 2017
The challenge
• Range of staff/
organisations
• Focus on small no of key
people in each organisation
• Capture the experience of
using NEWS

CLAHRC West
Qualitative Interviews
Organisation Interviews Planned
Ambulance/paramedics 3 1
Out of Hours /urgent care 2 2
Community care 2 2
Mental health 1
Primary care 7
Emergency Dept 0
Other 1 2
Total 16 7
Target 25-30?

CLAHRC West
Qualitative study
• Interviews - The focus …
– How does NEWS work?
– How is NEWS used?
– Where does NEWS work best?
– Where does NEWS not work so well?
– Who does NEWS work best with?
– Who else is using/not using NEWS?
– Scope for improvement/change?

CLAHRC West
Qualitative data
if there is a NEWS score that is just
creeping up slowly…then even just
taking precautions like put an IV
cannula in – I may not have done that
before
I think it’s like most of
these scoring systems. It’s
okay if you’re at the
extreme ends of it
It could support your decision making
to think ‘actually they don’t need to go
to A&E’. I could refer them to their
GP….and because they are low risk
that would be done safely

CLAHRC West
Qualitative data
It’s a quicker way of
communicating
danger.
You have to really to really tailor the language that you
use. You have to speak to GPs on the phone using much
more medical terminology to give them the confidence
that you do know what you’re on about … whereas the
nurses, they’d be much more interested in the NEWS
scores
I then called an ambulance
and then just told them the
NEWS score [7], and then
they were there within about
five minutes
It’s always difficult to convey when
you feel someone is really sick. So, it
does feel as though it kind of sums
that up.

CLAHRC West
Quantitative study
• Measuring the impact of NEWS quantitatively?
– Evidence from the systematic reviews
– Results from qualitative study
– Inform the design of quantitative measures
• Challenges
– NEWS is used as ‘hand over of care’ tool  patients
move between organisations  no single data
source/time point
• Suggestions …

CLAHRC West
Evaluation outputs
• Results and output
– Evaluate the use of NEWS in the region and
disseminate
– We can publish in peer review health care
journals
– Wider dissemination  the work done here
has the potential to influence development
and take up of NEWS across the UK

CLAHRC West
What next …
– Completion of systematic reviews (May/June)
– Qualitative study (May/June)
– Still looking for potential interviewees?
– Ideas/thoughts for quantitative study?
niamh.redmond@bristol.ac.uk

CLAHRC West
What next …
– Deteriorating Patient Programme
Evaluation Form – In delegate Packs
– Talk to us – CLAHRC stand or get in touch
Jon.Banks@Bristol.ac.uk Niamh.Redmond@Bristol.ac.uk
0117 342 1244 0117 342 1270
niamh.redmond@bristol.ac.uk

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The Deterioriating Patient: Let the numbers do the talking

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