Implementation of the National Early Warning Score in patients with suspicion of sepsis: evaluation of a system-wide quality improvement project

The National Early Warning Score (NEWS) was introduced to standardise early warning scores (EWS) in England. It has been recommended that NEWS should be used in pre-hospital care but there is no published evidence that this improves outcomes. In 2015, the West of England Academic Health Science Netw...

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Bibliographic Details
Published in:British journal of general practice 2020-06, Vol.70 (695), p.e381-e388
Main Authors: Pullyblank, Anne, Tavaré, Alison, Little, Hannah, Redfern, Emma, le Roux, Hein, Inada-Kim, Matthew, Cheema, Kate, Cook, Adam
Format: Article
Language:English
Subjects:
Early Warning Score
Emergency communications systems
England - epidemiology
Family physicians
Hospital Mortality
Humans
Primary care
Quality control
Quality Improvement
Sepsis
Sepsis - diagnosis
Sepsis - therapy
Vital signs
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Summary:The National Early Warning Score (NEWS) was introduced to standardise early warning scores (EWS) in England. It has been recommended that NEWS should be used in pre-hospital care but there is no published evidence that this improves outcomes. In 2015, the West of England Academic Health Science Network region standardised to NEWS across all healthcare settings. Calculation of NEWS was recommended for acutely unwell patients at referral into secondary care. To evaluate whether implementation of NEWS across a healthcare system affects outcomes, specifically addressing the effect on mortality in patients with suspicion of sepsis (SOS). A quality improvement project undertaken across the West of England from March 2015 to March 2019, with the aim of standardising to NEWS in secondary care and introducing NEWS into community and primary care. Data from the national dashboard for SOS for the West of England were examined over time and compared to the rest of England. Quality improvement methodology and statistical process control charts were used to measure improvement. There was a reduction in mortality in the SOS cohort in the West of England, which was not seen in the rest of England over the time period of the project. Admissions did not increase. By March 2019, the West of England had the lowest mortality in the SOS cohort in England. To the authors' knowledge, this is the first study demonstrating that use of NEWS in pre-hospital care is associated with improved outcomes in patients with SOS.
ISSN:0960-1643
1478-5242
DOI:10.3399/bjgp20X709349