NEWS: Saving lives across the world

Every so often, someone comes up with an idea that is so obvious, no one can
understand why it wasn’t thought of before. I am proud that the RCP’s National
Early Warning Score (NEWS) is one of those initiatives – not just a chart (or iPad) at
the end of the bed to record the patient’s physical signs and symptoms, but the
chart at the end of the bed – a single point of truth to unify recording of symptoms
across the NHS, consolidate training for doctors and nurses in the recording of
symptoms, and thereby improve patient safety.

When the RCP launched the NEWS in 2012, we hoped to see the score adopted
across the NHS. What has been more astonishing is the adoption of the score
internationally, with requests to use NEWS coming from health services across the
world from Europe to India and the USA, including the US Naval Air Forces!

Developing a national score was a logical extension of the RCP’s other initiatives to
improve the care of acutely ill patients, including the development of acute medical
units and the specialty of acute medicine. In developing NEWS, we took the decision
to make the chart free to download and use as the best way of encouraging NHS
trusts to take up the resource, and 3 years later our own survey showed that over
half of UK physicians were using it. Five years from launch, that number has
increased again, but we need to see NEWS implemented across all acute NHS
trusts, and we are grateful for the support of NHS England in making this happen.

As with any patient safety initiative, there was a need to review NEWS to ensure
that it was still fit for purpose. A review group examined the feedback and evidence
submitted to us, particularly on patients with COPD, and this revised version has
been produced as a result. Additional research and papers published on the
effectiveness of NEWS provided independent evaluation and demonstrated the
value of the system. Another benefit of NEWS is that a NEW score of 5 or more has
been validated as a robust way of detecting patients with infection who are at
clinical risk of acute deterioration due to sepsis, and the NEWS has now been
recommended by NHS England as the warning system to be used across the NHS in
assessing adults to help detect and treat sepsis earlier.

I would particularly like to thank the fantastic RCP team who made the update
possible – firstly Professor Bryan Williams for his unwavering enthusiasm for all
things ‘NEWS’, his championing of NEWS across the NHS, and steering the updating
process. I would also like to thank several RCP staff for the significant part that they
have played in the success of NEWS over the past few years – the RCP’s committee
manager for NEWS Tracy Scollin, RCP head of PR and public affairs Linda
Cuthbertson, and the RCP’s managing editor Natalie Wilder.

This update will mark the beginning of a new chapter as, with the support of NHS
England and NHS Improvement, over the next year NEWS will become the default
early warning score for NHS trusts and ambulances. Patients will benefit from its
implementation, and staff will benefit from not having to learn a new score each
time they join a new trust. And I hope that NEWS will continue its global journey,
saving lives across the world ...
Professor Jane Dacre

President, Royal College of Physicians

vi © Royal College of Physicians 2017

Endorsement from National Outreach

Forum
Since the publication of NEWS in 2012, critical care outreach teams, acute care
teams and members of the National Outreach Forum (NOrF) have worked with
enthusiasm and commitment to introduce and embed the NEWS into their
respective organisations and further afield. They have done this willingly in the firm
belief that standardising the process of patient assessment and the scoring,
recording and response to clinical deterioration will improve both clinical outcomes
and the quality of care for all patients.

The NOrF fully endorses the modifications and additions presented here within this
update of the NEWS (NEWS2), encouraged not only by the growing body of
evidence that supports these recommendations, but by their own clinical practice
experience. Using NEWS means that everybody is speaking a common language; it
provides a patient rather than an organisational focus and aids clear
communications throughout the patient pathway, from first responders in
prehospital care through to the acute setting and back again. The additional focus
of the NEWS2 document on using the NEWS to better identify patients at risk of
clinical deterioration due to sepsis is an important development. NOrF also fully
endorses the improvements and additions made to the remarkably successful free
web-based e-learning programme, and is firmly of the view that this has strongly
supported the dissemination and learning for all staff in the use of the NEWS scoring
system and observation chart in the UK.

Finally, we would like to acknowledge and thank critical care outreach and acute
care teams for their tireless commitment to patient safety. It is only correct that
these teams are now being referred to and acknowledged as the ‘safety engines of
our hospitals’. This document therefore serves as a reminder that the availability of
these teams 24/7 and the incorporation of NEWS should be integral to
organisational patient-safety strategies.

Lesley Durham RGN MA

NEWS Lead, National Outreach Forum

© Royal College of Physicians 2017 vii

Preface
The origin of the National Early Warning Score (NEWS) dates back to 2005, when I
was chair of the Royal College of Physicians (RCP) Acute Medicine Task Force, which
reported in 2007: Acute medical care: the right person, in the right setting – first
time. This report produced a template for the organisation of acute medical care in
our hospitals and contained a number of recommendations which have been
implemented nationally. From my perspective, the most important recommendation
in that report was the need for a standardised early warning system across the NHS,
a national early warning system, to better identify patients at risk of clinical
deterioration, to facilitate more timely and effective intervention and to save lives.
We therefore decided to take forward the development of the NEWS and the RCP
established the NEWS Development Group, which I was privileged to chair. This
resulted in the launch of the NEWS in 2012.

Developing and championing the merits of a single standardised system such as the
NEWS, for use across the NHS, was a major challenge, more than I could ever have
imagined when we began the work over 10 years ago. The challenge was not
because the process of developing and validating an early warning score was
intellectually difficult, or that we were developing a completely novel concept; on
the contrary, numerous early warning systems of varying complexity were already
in use in parts of the NHS. The challenge was convincing the proponents of the
many existing early warning systems of the huge advantages of ‘everybody using
the same system’ and not their system! I quickly learned that developing the NEWS
was relatively straightforward, compared with the challenge of system change on
the required scale. The step change that we were looking for was to standardise the
NEWS approach across the NHS, and link the scoring system to clearly defined
principles with regard to the required urgency of response, the competency of the
clinical responders, and the organisational infrastructure required to deliver an
effective clinical response to acute illness, every time it is needed. Simple and
pragmatic innovation done well can make a huge impact in healthcare, and the
NEWS had the potential to do the same.

The uptake and impact of the NEWS over the past 5 years have been extraordinary,
and beyond even the most optimistic expectations, especially considering that there
was no national incentive or directive to implement it. The majority of NHS hospitals
are now using the NEWS; over 120,000 NHS staff have voluntarily completed the
online NEWS training and accreditation programme; and the NEWS is being used by
many ambulance services and beginning to be used by some vanguard primary
care centres to help better triage acutely ill patients. The NEWS is being taught in
our medical and nursing schools and is increasingly being used at medical centres
across the world. The use of the NEWS as a quality indicator has also been recorded
by the Care Quality Commission during hospital inspections. The NEWS has been
evaluated in formal studies in the UK and across the world, and has been shown to
work very well. Moreover, evidence is beginning to emerge that where the NEWS
has been implemented, patient outcomes have improved and lives have been
saved.

Things looked very different in those early days during the development of the
NEWS, and when the concept of change on the scale we were proposing was
questioned and resisted on many fronts. After many difficult discussions, on many
occasions, there were times when I wondered whether we would ever get over the
line. These are the times when the support of colleagues in the NEWS Development
and Review Groups and the leadership and staff at RCP made a big difference. I also
learned the virtue of patience and the meaning of the ‘long game’. I have certainly
honed my political skills along the way!

And so, to this update, the NEWS2. We decided when the NEWS was launched that
we would undertake a review of the NEWS after 5 years. Although the NEWS has
performed very well in a variety of settings in the NHS and beyond, and substantial
peer-reviewed evidence of its effectiveness for its core purpose