GPs make decisions every day about whether a patient is deteriorating and needs to be admitted to hospital urgently. Early warning scores have been developed to identify patients who need urgent treatment.
They are routinely used in hospitals and although there isn’t much clear evidence to support their use, there is growing interest in using early warning scores in other locations such as GP surgeries, prisons and ambulance services. The most commonly used early warning score across the NHS is the ’national early warning score’ or NEWS.
NEWS is a simple scoring system of seven measurements, which are usually taken when patients are admitted or being monitored in hospital:
Each of these is scored from 0 to 3 and they are added together to give an overall score. Higher scores suggest that a patient is seriously ill. Measurements can be repeated to see how the patient is doing. If their score is lower, this suggests they are getting better, while an increase shows they are getting worse.
This project will look at whether there is evidence that early warning scores can predict outcomes in patients in hospitals and other healthcare settings.
We will look at ‘systematic reviews’ that have evaluated early warning scores in hospitals. Systematic reviews are literature reviews where researchers have looked at and appraised all the evidence available on a particular topic. This will tell us what outcomes and in which patients there is evidence to support the use of early warning scores.
We will also do our own systematic review of studies of early warning scores for predicting outcomes before patients are admitted to hospital. This will give information on the studies in pre-hospital settings, including GP surgeries.
We will compare the accuracy of early warning scores combined with clinical judgement, to GPs’ clinical judgement alone. We will use Gloucestershire out of hours GP service for this study, as they are starting to use a NEWS-based checklist. We will compare the results with a similar service that doesn’t use NEWS.
If we find that early warning scores are better at identifying deteriorating patients in primary care than GP judgement alone, we will develop another project. This will find out GPs’, other primary care staff, and patients’ views on using this approach.
This project aims to look at whether NEWS, in combination with GPs’ clinical judgement, is better at identifying patients who need urgent admission to hospital than clinical judgement alone.
We hope NEWS will help GPs’ to identify those patients who need urgent attention, giving them quicker access to medical help. If we find NEWS is better at identifying severely ill patients in a primary care setting than GPs’ clinical judgement alone, this will lead to improved outcomes for patients.