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Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out
  1. Lauren J Scott1,2,
  2. Niamh M Redmond1,2,
  3. Joanna Garrett3,
  4. Penny Whiting1,2,
  5. Kate Northstone1,2,
  6. Anne Pullyblank3,4
  1. 1 NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2 Population Health Sciences, University of Bristol, Bristol, UK
  3. 3 West of England Academic Health Science Network, Bristol, UK
  4. 4 Department of General Surgery, North Bristol NHS Trust, Bristol, UK
  1. Correspondence to Ms. Lauren J Scott, NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK; lauren.scott{at}


Background Early warning scores (EWS) were developed in acute hospital settings to improve recognition and response to patient deterioration. In 2012, the UK Royal College of Physicians developed the National Early Warning Score (NEWS) to standardise EWS across the NHS. Its use was also recommended outside acute hospital settings; however, there is limited information about NEWS in these settings. From March 2015, NEWS was implemented across the healthcare system in the West of England, with the aim that NEWS would be calculated for all patients prior to referral into acute care.

Aim To describe the distribution and use of NEWS in out-of-hospital settings for patients with acute illness or long-term conditions, following system wide implementation.

Method Anonymised data were obtained from 115 030 emergency department (ED) attendances, 1 137 734 ambulance electronic records, 31 063 community attendances and 15 160 general practitioner (GP) referrals into secondary care, in the West of England. Descriptive statistics are presented.

Results Most attendance records had NEWS=0–2: 80% in ED, 67% of ambulance attendances and 72% in the community. In contrast, only 8%, 18% and 11% of attendances had NEWS ≥5 (the trigger for escalation of care in-hospital), respectively. Referrals by a GP had higher NEWS on average (46% NEWS=0–2 and 30% NEWS ≥5). By April 2016, the use of NEWS was reasonably stable in ED, ambulance and community populations, and still increasing for GP referrals.

Conclusions NEWS ≥5 occurred in less than 20% of ED, ambulance and community populations studied and 30% of GP referrals. This suggests that in most out-of-hospital settings studied, high scores are reasonably uncommon.

  • clinical assessment
  • emergency care systems
  • prehospital care, communications
  • emergency ambulance systems emergency department

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  • Contributors All authors have made a substantial contribution to the design of the study, acquisition of the data or analysis of data; drafted or critically reviewed the manuscript; and approved the final submission.

  • Funding This research was jointly funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust and the West of England Academic Health Science Network. The views expressed are those of the authors and not necessarily those of NHS England, NHS Improvement, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Ethics approval This study used retrospective, fully anonymised, data from the participating NHS Trusts and therefore did not require ethics review as detailed in the Health Research Authority (HRA) Ethics toolkit. All data were treated confidentially and remained anonymous.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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