The Safer Care through Early Warning Scores programme provides a common approach to identifying and communicating about deteriorating patients across primary care, ambulance, hospital, community and mental health settings.

“The good news is that thanks to NEWS and the sepsis screening tool, the right response was received at the right place enabling the patient’s life to be saved.”

North Somerset Community Partnership

“I use it a lot talking with paramedics… It really helps to have a shared language.”

General Practitioner

What was the problem?

An Early Warning Score (EWS) is a guide used by medical services to quickly calculate the seriousness of a deteriorating patient’s condition. It is based on four physiological factors: blood pressure, heart rate, respiratory rate and body temperature, along with one observation – level of consciousness.

It was highlighted in the Royal College of Physicians Working Party report (July 2012) that a number of Early Warning Score ‘track-and-trigger’ systems are used routinely across the NHS, but that “various EWS systems are not necessarily equivalent or interchangeable. Put simply, when assessing acutely ill patients using these various scores, we are not speaking the same language and this can lead to a lack of inconsistency in the approach to detection and response to acute illness.”

NEWS event March 2016 (62)

What we did and why

The West of England Patient Safety Collaborative (PSC) decided to use a common approach across all our settings, and launched the Safer Care through Early Warning Scores programme in March 2015. All NHS healthcare providers in the West of England have agreed to use the National Early Warning Score (NEWS) as the EWS of choice.

The West of England AHSN is coordinating the project to systematically roll this out. We started by bringing together health commissioners, providers and patient groups to create a complete picture of existing systems, and holding workshops to explore issues and possible quick wins, and how to measure success. We are delivering the programme using quality improvement (QI) approaches and techniques, using the Institute of Healthcare Improvement (IHI) Breakthrough Series model, and sharing learning through regular stakeholder events across the region.

Like-for-like healthcare providers agree measures, baselines and local National Early Warning Score (NEWS) interventions to test in Plan, Do, Study, Act (PDSA) cycles, while geographic health communities work together to drive the project forward at the interfaces of care. We manage and facilitate sub-regional Health Community Task Groups (HCTGs) as drivers for NEWS, and three HCTGs meet every eight weeks, supported by the PSC.

Other ongoing work includes:

  • Development of training tools and delivery
  • Coordination of interoperability enablers
  • Measurement and evaluation

By the end of 2016/7, our goal is for all health professionals in the West to use NEWS to assess and monitor patients’ acuity and communicate this score at care interfaces resulting in measurable improvements to patient safety across the system. This will:

  • Improve ability to recognise deteriorating patients and institute rescue
  • Improve detection and treatment of sepsis
  • Improve communication between ambulance trust, primary care, acute hospitals, community and mental health services
  • Improve detection of acute illness in pre-hospital settings
  • Triage all patients objectively to ensure right place, right time, right clinician

Which national priorities does this work address?

  • NHS Business Plan, Five Year Forward View 15/16
  • National Early Warning Score, Royal College of Physicians
  • NICE guidance on the Deteriorating Patient
  • Sign up to Safety, NHS England

Results

In its first year, the programme has successfully rolled out the use of NEWS in:

  • All acute trusts in the West of England, including emergency departments
  • The South Western Ambulance Trust, where NEWS has been included in their electronic Patient Clinical Record
  • Both mental health trusts
  • GP out-of-hours services

Community services are using NEWS with certain cohorts of patients and are currently planning a full roll-out.

By September 2018, our adoption of NEWS should achieve:

  • 20% reduction in mortality from sepsis
  • 30% reduction in in-hospital cardiac arrests outside of intensive therapy units and critical care units
  • 50% reduction in transfers to intensive care units due to in-hospital deterioration or wrong placement, within 24 hours of emergency department admission

NEWS event March 2016 (63)

“Our strength lies in the commitment and enthusiasm of our members to work together on this programme to improve outcomes for patients. We have excellent stakeholder engagement and an appetite to collaborate at the boundaries of care to improve patient safety at both a regional and sub-regional level. We have received wider interest beyond the Patient Safety Collaborative to adopt our approach to system-wide change.”

Ellie Wetz, Patient Safety Improvement Lead, West of England AHSN

Tips for implementation

To find out more about the project and detailed tips for implementation please see the Implementing the National Early Warning Score toolkit.

Next steps and spread

  • Increasing engagement with GPs
  • Exploring challenges and barriers
  • Encouraging the adoption of NEWS in primary care settings

Contact for help and advice

Ellie Wetz, Patient Safety Improvement Lead, West of England AHSN
ellie.wetz@weahsn.net
0117 900 2604

Vanesther Rees, Communications Manager, West of England AHSN
vanesther.rees@weahsn.net
0117 984 1629

Programme duration: March 2015 – March 2016