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Scottish Resuscitation Group

Scottish Resuscitation Group. NEWS and Acute Medicine “there is no justification for the continued use of multiple different (generic) early warning scores to assess illness severity” . Professor Derek Bell Imperial College London Chelsea and Westminster Hospital. NHS E arly W arning

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Scottish Resuscitation Group

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  1. Scottish Resuscitation Group NEWS and Acute Medicine“there is no justification for the continued use of multiple different (generic) early warning scores to assess illness severity”. Professor Derek Bell Imperial College London Chelsea and Westminster Hospital

  2. NHS Early Warning Score Managing the continuum of care RCPL Acute Medicine Task Force Consensus Conference on Acute Medicine Nice (G 50) Acutely unwell patient Move from reports to delivery

  3. Survival post cardiac arrest • Schneider et al, 30 year review 1993 • 15% of patients survive in hospital cardiac arrest. • Peberdy et al, National Registry of Cardiopulmonary (NRCPR) arrest 2003 • 17% survival in > 14000 arrests • Nadkarni et al, NRCPR • 18% survival • VT/VF ~ 35% survival • PEA and asystole ~10%

  4. Patients in acute medical care • By volume the largest group of patients requiring in-patient beds • Recognised mortality • Patients per year • Acute Medical unit : In-patient ward (10-20:1) • Acute Medical Units • A significant part of the patient journey (40-50%)

  5. Standards for…… • Clinical outcomes • Patient safety • Patient outcomes • Experience • Staff, organisation and processes • Multi-professional • Capacity and capability • Facilities and environment • Support services • Cost effectiveness

  6. What we know • NCEPOD reports plus .... • Bell CM N Engl J Med 2001 • 3.8M emergency admissions • 23/100 causes of death > weekends • Barba R et al Eur J Int Med 2006 • Increased risk in first 48 hrs • Seward: Clin Med 2003 • Suboptimal care contributed to death in up to 20% Emergency Admissions:A journey in the right direction?

  7. Mortality – 2002-07Acute Medicine – 30 day (n=22744) P < 0.0001 *Odds ratio of dying 2007 vs 2002 = 0.47

  8. Illness patterns in medical patients the physiology of the system Point of Care Unstable McQuillan Concerns Assessment NEWS Stable 0-48Hours Days

  9. Response times to EWS score Beckett et al 2009

  10. NHS Early Warning Score Move from CPR to recognition and prevention

  11. NEWS principles • Point of entry to care • Including community • Continuum of care – the patient record • Routinely available data • Transferable between organisations Added Age and supplemental oxygen to EWS Smith GB et al Resuscitation 2008 plus expert input

  12. NEWS does not • Replace • Disease specific scores • Rockall • Higher acuity scores • APACHE • But • Does work in conjunction with others • HOTEL • And • Can support higher acuity scoring GCS

  13. NEWS can provide a • Single NHS system for early detection of the acutely unwell patient by the measurement of specific physiological parameters in a standardised format • Standardised score to determine illness severity to support consistent clinical decision making and clinical response • Standardisation of training and education in the detection and management of the acutely unwell patient • Adoption of a standardised scoring system throughout the acute hospital, not solely in the context of critical illness.

  14. NEWS can support • Consistent illness severity scoring throughout the patient journey, from pre-hospital and throughout their hospital care • Systems for audit which support promotion of high quality patient care • Planning of resource needs and allocation to match illness severity • Research through the use of a severity tool to assess the impact of interventions and quality of care.

  15. In Patient Data

  16. Age Supplemental oxygen Draft

  17. Locally responsive Response derived by local policy Opportunity to have area specific details e.g Pain

  18. Draft

  19. Do Study Act

  20. Impact of medical outliers (boarders)

  21. Educational programme • National • Local • Induction NHS Passport

  22. Next stages • Comments from • NEWS work group • Key Stakeholders • Royal College of Physicians • Test sites for validation • 20 – 30 sites • Ambulance service • Final modifications 2010

  23. Are we getting better?

  24. References • Bell CM, Redelmeier DA. Mortality among patients admitted to hospital on weekends as compared with weekdays. NEJM. 2001; 345:663 • Aylin P, Yunis A et al Weekend mortality for non-elective admissions in England – in press 2009 • The right person in the right setting – first time. RCPL 2007 • Prediction of in-hospital mortality and length of stay using an early warning scoring system: clinical audit. Paterson R, MacLeod DC, et al, 2006 Clin Med 6(3) • Assessment of clinical risk in the out of hours hospital prior to the introduction of Hospital at Night. Beckett DJ, Gordon CF, et al Acute Medicine 8(1) 2009. • Acutely ill patients in hospital. Recognition of and response to acute illness in adults in hospital. NICE clinical guideline 50. London: National Institute for Health and Clinical Excellence. NICE); • H. Gao, A. McDonnell, et al, Systematic review and evaluation of physiological track and trigger systems for identifying at risk patients on the ward, Intensive Care Med 33 (2007

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