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Observational Study
. 2020 May 28;70(695):e374-e380.
doi: 10.3399/bjgp20X709337. Print 2020 Jun.

Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care

Lauren J Scott  1 , Niamh M Redmond  1 , Alison Tavaré  2 , Hannah Little  2 , Seema Srivastava  3 , Anne Pullyblank  4
Affiliations
Observational Study

Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care

Lauren J Scott et al. Br J Gen Pract. .

Abstract

Background: 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 GPs 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: An observational study using routinely collected data from primary and secondary care.

Method: NEWS values were prospectively collected for 13 047 GP referrals into acute care between July 2017 and December 2018. 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, for example, median 94 minutes (interquartile range [IQR] 69-139) for NEWS ≥7; median 132 minutes, (IQR 84-236) for NEWS = 0 to 2); faster time from hospital arrival to medical review (54 minutes [IQR 25-114] for NEWS ≥7; 78 minutes [IQR 34-158] for NEWS = 0 to 2); as well as increased length of stay (5 days [IQR 2-11] versus 1 day [IQR 0-5]); intensive care unit admissions (2.0% versus 0.5%); sepsis diagnosis (11.7% versus 2.5%); and mortality, for example, 30-day mortality 12.0% versus 4.1% for NEWS ≥7 versus NEWS = 0 to 2, respectively. On average, for patients referred without a NEWS value (NEWS = NR), most clinical outcomes were comparable with patients with NEWS = 3 to 4, but ambulance conveyance time and time to medical review were comparable with patients with NEWS = 0 to 2.

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

Keywords: continuity of care; general practice; national early warning score; patient safety; primary care; routinely collected data; secondary care.

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Figures

Figure 1.
Figure 1.
Time from GP referral to arrival in hospital by NEWS on referral and ambulance conveyance. CI = confidence interval. GMR = geometric mean ratio. NEWS = National Early Warning Score. NR = not recorded.
Figure 2.
Figure 2.
Time from hospital arrival to doctors’ review by NEWS on referral. CI = confidence interval. GMR = geometric mean ratio. NEWS = National Early Warning Score. NR = not recorded
Figure 3.
Figure 3.
Overnight hospital stay and/or hospital mortality by NEWS on referral. CI = confidence interval. NEWS = National Early Warning Score. NR = not recorded.
Figure 4.
Figure 4.
Primary diagnosis of sepsis by NEWS on referral. CI = confidence interval. NEWS = National Early Warning Score. NR = not recorded.
Figure 5.
Figure 5.
Two-day mortality by NEWS on referral. CI = confidence interval. NEWS = National Early Warning Score. NR = not recorded.
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