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Review
. 2022 Nov;22(6):499-505.
doi: 10.7861/clinmed.2022-news-concept.

The National Early Warning Score: from concept to NHS implementation

Bryan Williams  1
Affiliations
Review

The National Early Warning Score: from concept to NHS implementation

Bryan Williams. Clin Med (Lond). 2022 Nov.

Abstract

This year is the 10th anniversary since the launch of the National Early Warning Score (NEWS) by the Royal College of Physicians in 2012. This review reflects on the journey, from the nascent concept of a standardised system to detect acute illness severity and clinical deterioration through to the adoption of NEWS2 by the NHS and, ultimately, its incorporation into quality indicators of acute care provision. The impact of NEWS/NEWS2 on the transformation of provision and configuration and training of acute care teams in hospitals is reviewed. User feedback has been key in iterating guidance on the use of NEWS/NEWS2 and key elements of this are discussed. The ultimate aim of NEWS was to improve patient outcomes with acute illness or deterioration and the impact on outcomes is now becoming apparent but, paradoxically, an effective response can eliminate the link between the score and the ultimate outcome. This review concludes with a reflection on what the next 10 years may bring, particularly with the digital transformation of healthcare and its potential impact on scoring systems, as well as the necessary permeation of NEWS2 beyond the acute hospital setting into emergency response triage in primary and community care settings.Ten years on, via NEWS/NEWS2, the NHS is the first healthcare system globally with a 'common language' of illness severity and a standardised early warning system for acute clinical illness and deterioration, a system that is now being replicated in many other areas of the world.

Keywords: NEWS; NEWS2; NHS; early warning scores; implementation.

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Figures

Fig 1.
Fig 1.
An early iteration of the National Early Warning Score chart showing the repeated scoring of physiological parameters from a patient who developed a urine infection in hospital. Note the coincidence of the rise in respiratory rate, pulse rate and temperature as the patient developed a fever and the marked escalation of the aggregate score from 1 to 5–6. Followed by a similar time pattern of rapid resolution after prompt treatment of the patient with antibiotics.
Fig 2.
Fig 2.
Area under the receiver operating curves for the National Early Warning Score and 33 other early warning score systems previously evaluated using the system scores relative to each outcome studies. 35,585,patient episodes and 198,755 vital signs datasets. ICU = intensive care unit; NEWS = National Early Warning Score. Adapted with permission from Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score (NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and death. Resuscitation 2013;84:465–70.
See this image and copyright information in PMC

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References

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