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Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out

Research output: Contribution to journalArticle

Original languageEnglish
Pages (from-to)287-292
Number of pages6
JournalEmergency Medicine Journal
Issue number5
Early online date6 Mar 2019
DateSubmitted - 21 Sep 2018
DateAccepted/In press - 14 Jan 2019
DateE-pub ahead of print - 6 Mar 2019
DatePublished (current) - 1 May 2019



Early warning scores (EWS) were developed in acute hospital settings to improve recognition and response to patient deterioration. In 2012, the UK Royal College of Physicians developed the National Early Warning Score (NEWS) to standardise EWS across theNHS. Its use was also recommendedoutside acute hospital settings ;however, there is limited information about NEWS in these settings. From March 2015, NEWS was implemented across the healthcare system in the West-of-England, with the aim that NEWS would be calculated for all patients prior to referral into acute care.


To describe the distribution and use of NEWS in out-of-hospital settings for patients with acute illness or long-term conditions, following system wide implementation.


Anonymised data wereobtained from 115,030 ED attendances,1,137,734 ambulance electronic records,31,063 community attendances and 15,160 GP referrals into secondary care, in the West of England. Descriptive statistics are presented.


Most attendance records had NEWS=0-2: 80% in ED, 67% of ambulance attendances and 72% in the community. In contrast, only 8%, 18% and 11% of attendances had NEWS≥5 (the trigger for escalation of care in-hospital), respectively. Referrals by a GP had higher NEWS on average (46% NEWS=0-2 and 30% NEWS≥5). By April 2016, the use of NEWS was reasonably stable in ED, ambulance and community populations, and still increasing for GP referrals.


NEWS≥5 occurred in less than 20% of ED, ambulance and community populations studied, and 30% of GP referrals. This suggests thatin most out-of-hospital settings studied, high scores are reasonably uncommon.

    Research areas

  • clinical assessment, emergency ambulance systems emergency department, emergency care systems, prehospital care, communications

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