• Mohammed A Mohammed, Muhammad Faisal, Donald Richardson, Andy Scally, Robin Howes, Kevin Beatson, Sally Irwin, and Kevin Speed.
• The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Midlands, UK and University of Bradford Faculty of Health Studies, Bradford, UK m.a.mohammed5@bradford.ac.uk.
• Clin Med (Lond). 2019 Mar 1; 19 (2): 104108104-108.

BackgroundThe National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care.MethodsAnalysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium.ResultsThe number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH.ConclusionsThe addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.© Royal College of Physicians 2019. All rights reserved.

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