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Are referrals to hospital from out-of-hours primary care associated with National Early Warning Scores?
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    NEWS used without clinical judgement is of limited value
    • Alison Tavare, GP and Primary Care Clinical Lead West of England Academic Health Science Network
    • Other Contributors:
      • Anne Pullyblank, Medical Director and Consultant Surgeon
      • Matthew Inada Kim, Consultant Acute Physician and National Clinical Lead for Deterioration, Specialist Advisor for Sepsis
      • Hein Le Roux, GP and Clinical Associate
      • Emma Redfern, Associate Clinical Director Patient Safety, Consultant in Emergency Medicine, Deputy Medical Director
      • Lauren J Scott, Senior Research Associate

    Finnikin and colleagues describe a large data set of retrospectively calculated National Early Warning Scores (NEWS) in a system that was not using or responding to NEWS. Understanding the relationship between NEWS and referral practices is an important area of research which could help shed some light on the impact of introducing NEWS into primary care.

    The first important point is that only 31% (74,992/242,451) of patients who had face-to-face encounters had a full set of observations and the clinical characteristics of the 69% excluded from the study are unknown. In our experience, GPs tend to perform a full set of observations on patients who appear more unwell so it is possible that the population studied may not be representative.

    Finnikin and colleagues found that only 6.9% of patients referred to hospital had a NEWS≥5 and 69% with a NEWS ≥5 were not referred. There is emerging evidence that NEWS calculated by GPs at referral correlates with mortality (data from West of England accepted for publication) so the fact that it did not correlate with referral is of concern. Scott et al in the West of England (1, 2) and Inada Kim et al in Wessex (unpublished data) have demonstrated that the higher the NEWS on referral or arrival, the more likely the patient is to be admitted and the more likely the patient is to die.

    The lack of linkage to any outcomes is a major weakness of this work. While an increase in admissions of 16.2% is not ideal in an alr...

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    Conflict of Interest:
    None declared.