Clinical medicine (London, England)
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The cause of deterioration is often unclear, so it is vitally important that we spot the sick and deteriorating patient from all causes. As a result, warning scores must cater for all conditions, and - where possible - be standardised across all healthcare settings. This article summarises the importance of an 'unblinkered' approach to acute illness assessment, comparing and examining the evidence for different historical scoring systems and looking at the early impact of national alignment to NEWS2 in patients admitted to hospital with suspected bacterial infections.
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The National Early Warning Score 2 (NEWS2) is the established track and trigger system to assess illness severity and risk of deterioration for patients in acute episodes of care in the UK. It is also increasingly used internationally. In this article, we outline established and recommended practice for initial and ongoing assessment. We also highlight where practice may not meet these standards, how the full context and assessment of the patient is paramount, and opportunities for more accurate assessment in the future.
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The emergence of the COVID-19 pandemic resulted in a dramatic increase in acutely ill patients presenting to hospitals with life-threatening acute respiratory disease. There was an immediate need for effective triage systems to facilitate clinical decision making. This review assesses the performance of the National Early Warning Score 2 (NEWS2) in two contexts. ⋯ A NEWS2 of 5 had high short-term sensitivity within and was unlikely to miss patients with COVID-19 who go on to deteriorate, but this comes with moderate specificity. However, the specificity of these systems is likely underestimated because preventing deterioration is their purpose. NEWS2 is an adjunct to clinical decision making and has served that purpose during the COVID-19 pandemic, playing an important role in communicating illness severity, clinical deterioration, triaging patients to appropriate levels of care and prompting completion of treatment escalation plans for those with high scores and at imminent risk of deterioration.
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This year is the 10th anniversary since the launch of the National Early Warning Score (NEWS) by the Royal College of Physicians in 2012. This review reflects on the journey, from the nascent concept of a standardised system to detect acute illness severity and clinical deterioration through to the adoption of NEWS2 by the NHS and, ultimately, its incorporation into quality indicators of acute care provision. The impact of NEWS/NEWS2 on the transformation of provision and configuration and training of acute care teams in hospitals is reviewed. ⋯ The ultimate aim of NEWS was to improve patient outcomes with acute illness or deterioration and the impact on outcomes is now becoming apparent but, paradoxically, an effective response can eliminate the link between the score and the ultimate outcome. This review concludes with a reflection on what the next 10 years may bring, particularly with the digital transformation of healthcare and its potential impact on scoring systems, as well as the necessary permeation of NEWS2 beyond the acute hospital setting into emergency response triage in primary and community care settings. Ten years on, via NEWS/NEWS2, the NHS is the first healthcare system globally with a 'common language' of illness severity and a standardised early warning system for acute clinical illness and deterioration, a system that is now being replicated in many other areas of the world.
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As more healthcare is provided in non-hospital settings, it is essential to support clinicians in recognising early signs of clinical deterioration to enable prompt intervention and treatment. There are intuitive reasons why the use of the National Early Warning Score 2 (NEWS2) in out-of-hospital settings may enhance the community response to acute illness by using a common language across healthcare. An additional advantage of the use of NEWS2 in community settings is that it is not disease specific and requires no expensive technology or great expertise to take a full set of observations that can be an indicator of clinical acuity. However, concerns have been expressed as NEWS2 was developed in acute hospital settings that it may not be applicable in community settings; this review shares some of the practical ways that NEWS2 can support clinical practice along with the emerging published evidence.