NHS England and NHS Improvement have endorsed a single early warning score – the National Early Warning Score (NEWS) – for use in acute and ambulance settings.
NEWS is a tool developed by the Royal College of Physicians which improves the detection and response to clinical deterioration in adult patients and is a key element of patient safety and improving patient outcomes.
Since its initial launch in 2012, NEWS has seen widespread uptake across the NHS. At present around 70% of acute trusts in England are using NEWS, with other Early Warning Scores in place in other areas. The confusion caused by the current variation in practice can compromise patient safety, something that would be eliminated by use of a common tool. With this in mind, NHS England, with the support of NHS Improvement are endorsing NEWS, and are launching an ambition to increase its use to 100% of acute and ambulance settings by March 2019.
Through standardisation of NEWS we can reduce the number of patients whose conditions deteriorate whilst in hospital, and potentially save over 1800 lives a year.
NHS England have set up a Cross-System Working Group that will work to increase the uptake of NEWS and ensure its standardised implementation. With representation from: NICE, CQC, AHSNs, clinicians and academics the group will seek to:
- Implement the national ambition to increase the uptake of NEWS
- Develop and oversee a work programme to ensure all NEWS-related activity is consistent with the national ambition and identify any barriers to standardised uptake.
If you would like more information on NEWS, please see the RCP website or further links in the FAQ below.
Frequently Asked Questions
The NEWS is a well validated track-and-trigger early warning score system that is used in the majority of UK hospitals to identify and respond to patients at risk of deteriorating. It is based on a simple scoring system in which a score is allocated to physiological measurements already undertaken when patients present to, or are being monitored in health care settings. The National Quality Board strongly endorses the use of NEWS as the standardised system for the assessment of acute illness in adults and communication between healthcare practitioners.
The following six simple physiological parameters are included in the scoring system:
- Respiratory rate
- Oxygen saturations
- Systolic blood pressure
- Pulse rate
- Level of consciousness
A score is allocated to each physiological parameter, the magnitude of the score reflecting how extreme the parameter varies from the norm. This score is then aggregated, and uplifted for people requiring oxygen. These parameters are already routinely measured in hospitals and recorded on the observation charts.
An elevated NEWS score does not provide a diagnosis; it helps identify a sick patient who requires urgent clinical review in a standardised way. It is simple and pragmatic. NEWS also allows healthcare professionals to communicate about deteriorating patients in a common language.
Full details on NEWS and links to NEWS training resources and charts containing the recommended clinical thresholds and materials for use are available from the RCP website at the links below.
NEWS can be used in all adults aged 16 or over (except pregnant women) and across all healthcare settings. It is particularly useful when patients are transferred from one setting to another – to ensure there is a clear understanding of the patient’s clinical state, risk of deterioration and prognosis.
NEWS was originally developed as a tool to detect deterioration in hospital. The score is most useful when repeated measurements are taken over time to detect deviation from an established baseline.
Clinical judgement should always be used, even if the NEWS is normal. Healthcare professionals should escalate deteriorating patients for review whenever they are concerned, even if the NEWS appears to be reassuring. In addition the recommended frequency of observations and review/escalation should be increased if there is clinical concern that the patient appears to be more unwell than the recorded NEWS Score.
Although accurate recording of the NEWS is important, reliable response and escalation is equally important. This should be the same whether paper or electronic systems are used.
The frequency of observations and review/escalation is based upon the aggregate NEWS (as outlined in the RCP guidance); however, this should be increased / escalated if there is concern (or ‘gut feel’) that the patient is sicker than they appear.
Please see below for when NEWS should not be used in specific settings.
NEWS should be used for all pre-hospital patients who are ill or at risk of deteriorating, including those suspected of having sepsis. In 2017, The Association of Ambulance Chief Executives (AACE) published a supplement to their UK ambulance services clinical practice guidelines recommending the use of NEWS.
However NEWS should not be used as the sole criteria for prioritisation of patients being admitted to hospital via ambulance services.
All acute organisations are expected to use NEWS for all patients over the age of 16, except pregnant women.
Over 70% of hospitals in England already use NEWS, and the use of multiple different (non-NEWS) early warning scores across regions should be actively discouraged.
Additionally, modification of NEWS from that published by the RCP is also discouraged. This should reduce the variation in identification and response to deteriorating patients in England.
Acute Mental Health settings
NEWS should be used to assess physical deterioration in acute mental health facilities. It should also be used for communication and handover when patients are transferred to and from acute hospitals.
The Royal College of GPs encourages use of a full set of observations when assessing deteriorating patients. Although there is currently limited evidence for the predictive value of NEWS in the community or primary care setting, it provides an objective assessment of a patient’s physiological state and adds to clinical judgement. For example, it may be useful to measure baseline NEWS in frail patients in order to detect a change against this baseline.
NEWS can also facilitate communication at the interfaces of care such as when requesting ambulance transfer or hospital assessment. It allows colleagues to prioritise resources and identify deterioration early.
In December 2017, the RCP have published NEWS2 as an update to NEWS. Both NEWS and NEWS2 follow the same principles and trigger thresholds. We would expect healthcare professionals and organisations to use either NEWS or NEWS2. In practice it is expected that clinicians and organisations will adopt NEWS2 in order to improve the appropriateness of escalation in patients with chronic hypoxaemia and to include acute delirium or confusion within their assessments.
We would strongly encourage learning from hospitals that have already adopted NEWS. In addition, the regional Patient Safety Collaboratives will be supporting adoption of NEWS through their acute deterioration work stream.
A hospital will be deemed to be NEWS compliant if it uses the NEWS scoring system as part of its recording of vital signs and escalation processes.
NEWS should not be used in children (under 16 years), or pregnant women.
NHS England and NHS Improvement are considering the evidence for use of the Paediatric Early Warning Score (PEWS) and Modified Early Obstetric Warning Score (MEOWS) and are not making any specific recommendations at this stage. NHS England are discussing with the Royal College of Paediatrics and Child Health what we can do together to move towards a more standardised PEWS to assist in the assessment of acutely ill children outside specialised paediatric units
NEWS should not be applied in the obstetric population. This is because the physiological changes of pregnancy can render the existing National Early Warning Score inappropriate. Additionally, the physiological response to acute illness can be modified in children and by pregnancy; and baseline physiological parameters are different in these two populations when compared with the non-pregnant adult population.
The NICE guidelines on the acutely ill adult patient in hospital (NG50) and on Sepsis: recognition, diagnosis and early management (NG51) do not include any evidence-based recommendations concerning the use of NEWS.
NICE does, however, support the use of NEWS as part of a pragmatic approach in the NHSE implementation advice on identifying people who should be clinically assessed for potential sepsis. NICE is also a member of the National Quality Board that strongly endorses the use of NEWS in adult patients as the standardised system for assessment of the severity of acute illness in adults and communication of this between healthcare practitioners.
NICE advocates more research into how early warning scores such as NEWS can be used to improve the detection of sepsis and facilitate prompt and appropriate clinical response in pre-hospital settings and in emergency departments.
- Royal College of Physicians National Early Warning Score (NEWS2)
- NEWS Online Training Resource
- NHS England Sepsis Guidance Implementation Advice
- NICE National Guidance 51 Sepsis: recognition, diagnosis and early management
- Neutropenic sepsis: prevention and management in people with cancer
- RCEM Sepsis Toolkit 2014
- NHS England Cross-system sepsis action plan 2017
- NICE Antimicrobial stewardship; Quality Standard 121
- Clinical research on NEWS – study example 1: Emergency Medical Journal
- Clinical research on NEWS – study example 2: British Journal of Hospital Medicine