This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
The National Early Warning Score (NEWS2) is calculated using routine vital sign measures of temperature, pulse and so on. It is used by ambulance staff and emergency departments to identify sick adults whose condition is likely to deteriorate. The score is used for care home residents but with little understanding of how well they work for this population. New research shows that, among care home residents admitted to hospital as an emergency, NEWS2 can effectively identify people whose condition is likely to get worse.
NEWS2 has been shown to work among the general population. However, before this study, it was unclear if it could monitor the condition of care home residents because of their age, frailty, and multiple long-term conditions.
Researchers analysed medical records for 665 UK care home residents admitted to hospitals in an emergency. They found that higher NEWS2 scores predicted longer hospital stays and death.
This finding will be useful to hospital teams caring for care home residents when they arrive at hospital in an emergency. It suggests that NEWS2 scores, along with their clinical judgement, can identify care home residents in hospital at high risk of a serious worsening in their condition.
The issue: is NEWS2 accurate for care home residents in hospital?
A NEWS2 score is used to monitor people’s condition when they are unwell, and support clinical decision making. The higher the score, the more likely the person is to need urgent medical attention.
The score is based on someone’s temperature, pulse, blood pressure, breathing rate, oxygen levels, and level of consciousness. Lower scores mean that someone is at low risk and can simply be monitored. Higher scores suggest emergency medical care is needed.
There is good evidence to show that NEWS2 can predict poor outcomes (such as death or admission to critical care) among hospital patients in general. It is increasingly used in care homes aiming to improve care for residents when they become unwell, despite the lack of evidence in this population. Concerns have been raised that care home residents’ age, frailty, and multiple long-term conditions could make the score less applicable in this group, and less able to predict poor outcomes.
This study explored how well NEWS2 predicted poor health outcomes among care home residents having an emergency admission to hospital.
The researchers analysed audit data for 665 UK care home residents aged 60 years and older admitted to 160 hospitals on two days (27 June 2019 and 30 January 2020). Most (7 in 10) were older than 80 years.
The researchers considered whether NEWS2 scores were associated with a number of outcomes, including:
- inpatient care 7 days after admission (either prolonged stays or readmission)
- death within 7 days of admission.
On admission, people were assessed and given a NEWS2 score. More than half (54%) of residents had low scores, and some were intermediate (18%). Others were high (13%) or critically high (16%).
The researchers found that, compared with someone with a low NEWS2 score:
- people with high scores were 3 times more likely, and those with critically high scores 9 times more likely, to have a hospital stay of more than 7 days
- people with high scores were 14 times more likely, and those with critically high scores 54 times more likely, to die within 7 days of admission.
Why is this important?
Care home residents who have higher NEWS2 scores when they have an emergency admission to hospital were more likely to have a long hospital stay and to die within 7 days. Clinicians could use NEWS2 scores to identify care home residents at high risk of worsening condition, alongside their clinical judgement, the authors say.
High and critically high scores could indicate that a care home resident may be approaching the end of their life. This would allow clinicians to discuss treatment or end of life care options with families and carers.
Reflections for clinicians
How much weight should I give to NEWS2 alongside my clinical judgement?
Can I make more use of NEWS2 scores to improve care for my patients living in care homes?
More research is needed to see if NEWS2 scores measured in care homes (rather than hospitals) can predict health outcomes or improve care within care homes. The study team is continuing its work in this area.
You may be interested to read
This Alert is based on: Barker RO, and others. National Early Warning Scores Following Emergency Hospital Transfer: Implications for Care Home Residents. Journal of the American Medical Directors Association 2023; 24: 653 – 656.
A video from the British Journal of General Practice about using NEWS2 in care homes.
Information for clinicians on NEWS2 from Patient Safety.
A video explanation of how to measure NEWS2.
Funding: the study was funded by the NIHR School for Primary Care Research.
Conflicts of Interest: none declared.
Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.