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National Early Warning Scores in primary care are associated with clinical outcomes

Research output: Contribution to journalArticle

  • Lauren J Scott
  • Niamh M Redmond
  • Alison Tavare
  • Hannah Little
  • Seema Srivastava
  • Anne Pullyblank
Original languageEnglish
JournalBritish Journal of General Practice
DateAccepted/In press - 7 Jan 2020

Abstract

Introduction
NHS England has mandated use of the National Early Warning Score (NEWS), more recently NEWS2, in acute settings, and suggested its use in primary care. However, there is reluctance from General Practitioners to adopt NEWS/NEWS2.

Aim
To assess whether NEWS calculated at the point of GP referral into hospital is associated with outcomes in secondary care.

Design and Setting
Observational study of primary and secondary care using routinely collected data.

Methods
Between July 2017 and December 2018, NEWS was prospectively collected for 13,047 GP referrals into acute care. NEWS values were examined, and multivariate linear and logistic regression used, to assess associations with process measures and clinical outcomes.

Results
Higher NEWS values were associated with faster conveyance for patients travelling by ambulance (e.g. median 94 minutes, interquartile range [IQR] 69 to 139 for NEWS=7+; median 132 minutes, IQR 84 to 236 for NEWS=0-2) and faster time from hospital arrival to medical review (54 minutes [25 to 114] for NEWS=7+; 78 minutes [34 to 158] for NEWS=0-2), as well as increased length of stay (5 days [2 to 11] vs. 1 day [0 to 5]), intensive care unit admissions (2.0% vs. 0.5%), sepsis diagnosis (11.7% vs. 2.5%), and mortality (e.g. 30 day mortality 12.0% vs 4.1%) for NEWS=7 vs. NEWS=0-2 respectively. On average, for patients referred without a NEWS value, most clinical outcomes were comparable to patients with NEWS=3-4, but conveyance times without ambulance transport were longer than for patients with any calculated NEWS.

Conclusion
We have demonstrated that higher NEWS values calculated at GP referral into hospital are associated with a faster medical review and poorer clinical outcomes.

    Research areas

  • Primary care, General Practice, Secondary Care, National Early Warning Score, Continuity of care, Patient safety, Routinely collected data

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Documents

  • Full-text PDF (accepted author manuscript)

    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Royal College of General Practitioners at [insert hyperlink] . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 273 KB, PDF document

    Embargo ends: 1/01/99

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