National Early Warning Score (NEWS) Performance in a Veterans Affairs 1b Emergency Department: Results of a Quality Improvement Initiative

Abstract

RATIONALE The National Early Warning Score (NEWS) is an early warning scoring that has been modified and scaled to detect early clinical deterioration in different clinical settings outside the intensive care unit (ICU). Previous epidemiological studies of NEWS were in non-Veterans Affairs (VA) populations. Little data exist on NEWS deployment in a VA-setting. Our study aims to evaluate how the NEWS performed in a VA 1b facility emergency department (ED). These results are important to evaluate if the NEWS scoring system is reliable in a VA population with shorter time frames inherent to ED settings. METHODS This was a quality improvement initiative to standardize recognition of clinically deteriorating patients in a VA 1b ED. The project team was multidisciplinary in nature: ED medical director, ED clinical nurse leader, pharmacists, informatics specialists, clinical nurse educators, and administrative leadership. A review of the literature was done, followed by weekly meetings in which the project design took place. The time frame for project development and deployment was September 2018 to March 2019. Informatics technology was built that incorporated the NEWS into electronic health record workflows. This was then integrated into nursing and physician workflows and tied to ED disposition decisions. Patient outcomes were then tracked via the construction of an analytics solution. RESULTS 5561 NEWS scores were obtained for 2399 patients from 2878 ED visits between December 2018 to October 2019. The median age of the patients 67 (60-74) years [male: 69 (61-74)]; [female: 60 (50-67)]. In each ED visit, patients had an average of 1.93 scores recorded. There was a total of 338 (6%) ICU admissions within 24hrs of score; of 141 patients with NEWS over 7, 52 (36.9%) were admitted to ICU within 24 hours. Only 286 (5.3%) of patients with NEWS <7 were admitted to the ICU within 24 hours (p < 0.001). A total of 4 deaths (0.07%) and 1 cardiac arrest within 24 hours of a NEWS were noted; no association with NEWS was noted. CONCLUSION In this quality improvement project at a VA 1b facility, NEWS was evaluated as a potential early warning system in the emergency department. NEWS is a promising early warning score that could have an application in VA ED settings, but more research is needed.