Use of the National Early Warning Score (NEWS) in the care of surgical patients

  • Caroline M. S. Kovacs

Student thesis: Doctoral Thesis

Abstract

The National Early Warning Score (NEWS) is a clinical tool that combines vital sign
observations of patients in hospital to indicate how unwell the patient is. It was recommended for adoption across NHS England and Wales by the Royal College of Physicians London in 2012. Associated protocols further dictate escalation of care based on NEWS value, ranging from increasing frequency of observations, through clinical review of the patient, to emergency assessment by the critical care team. NEWS has been extensively validated for the use in medical patients. This study investigated the suitability of NEWS for use in surgical patients.
The pilot study suggested NEWS’s ability to identify deterioration in surgical patient was comparable to its performance in medical patients. For the initial study, no information was available on patient operative status, i.e. whether observations were taken pre- or post-theatre or the patient was discharged without an operation. For the main study, the dataset was therefore extended to include operating theatre data.
Analysis was limited to 200,000 non-elective admissions. Data were split into medical and surgical patient groups, and divided by the number of visits to operating theatre. Descriptive statistics, NEWS distributions, outcome rates including mortality, and
efficiency curves were generated. The ability of NEWS to discriminate outcome was assessed.
Compared to medical patients, surgical patients were found to have a lower average age, proportionately fewer high NEWS values, with higher associated observed risk. Results indicated the trigger level for surgical patients prompting clinical review could be reduced from NEWS of 5 to 4, without increasing workload on ward staff.
In summary, NEWS was validated as suitable for use in the care of surgical
patients. Further investigation of the lower trigger level for surgical patients was
suggested but this is a decision that can only be taken by the Royal Colleges.
Date of Award2021
Original languageEnglish
SupervisorDavid Prytherch (Supervisor), Jim Briggs (Supervisor) & Philip James Scott (Supervisor)

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