Early warning scores: a sign of deterioration in patients and systems

Abstract

Abstract:The early warning score is a decision-making tool that has a simple design, yet its implementation in healthcare organisations is proving complex. This article reports the results of a survey that evaluated the nurses' experiences of using the NEWS (National Early Warning Score) in an acute hospital in Ireland. Staff reported that the NEWS was easy to use, did not increase workload and enhanced their ability to identify deteriorating patients. However, they also identified problems related to doctors' delayed response times, doctors lack of training in the use of the tool, and a failure by doctors to modify parameters for patients with chronic conditions. NEWS enhances nurses' role in early detection of patient deterioration but delays in response times by doctors, exposes systematic flaws in healthcare. This suggests that it is not only an indicator of patient deterioration but also of deteriorating healthcare systems.

National Early Warning Score: A survey of registered nurses' perceptions, experiences and barriers

“…There was a large discrepancy between the study by Fox and Elliot () and our study concerning the item “Using the escalation criteria, I get a better response from the doctor” (Fox & Elliot, ). Approximately half of the RNs in our study answered positively compared to just above 10% in the study by Fox and Elliot (). This might be due to a higher density of doctors in the Swedish setting or a more successful implementation of the NEWS.…”

“…The questionnaire was based on the original validated self-report questionnaire by Green and Allison (2006), which was further developed for use in a more recent study by Fox and Elliot (2015) with the inclusion of demographic questions, Likert scale questions about participants' experiences of using the NEWS and open comment sections (Fox & Elliot, 2015;Green & Allison, 2006).…”

“…However, all these earlier problems have been addressed with the implementation of the NEWS (Royal College of Physicians, ). Studies have been performed more recently with the aim of clarifying whether barriers still existed to the use of the NEWS (Fox & Elliot, ; Petersen et al, ). RN's in Ireland, in a questionnaire study by Fox and Elliot (), indicated problems relating to doctors' delayed response times, doctors' lack of training in the use of the NEWS and a failure by doctors to modify trigger parameters for patients with chronic conditions (Fox & Elliot, ).…”

“…Studies have been performed more recently with the aim of clarifying whether barriers still existed to the use of the NEWS (Fox & Elliot, ; Petersen et al, ). RN's in Ireland, in a questionnaire study by Fox and Elliot (), indicated problems relating to doctors' delayed response times, doctors' lack of training in the use of the NEWS and a failure by doctors to modify trigger parameters for patients with chronic conditions (Fox & Elliot, ). Furthermore, RN in a Danish interview study stated that interpersonal relations between nurses and doctors could cause barriers to patient care and that under‐staffing or time constraints could act as barriers in adherence to the monitoring protocol (Petersen et al, ).…”

Strengths and limitations of early warning scores: A systematic review and narrative synthesis

“…6 The NEWS was shown to be independently valid, 7 and surveys showed that staff found the NEWS was easy to use, did not increase workload and enhanced their ability to identify deteriorating patients. 8 NEWS has been widely adopted throughout the UK National Health Service. Patients w ith a MEWS >6 had 21 times the odds of death compared w ith those w ith a score of <1.…”