Organisation implements a regional project to adopt national early warning score within clinical practice, improving recognition and management of deteriorating patients

* Please provide a brief outline of your work.

The West of England AHSN (WEAHSN) has led a three-year programme to improve recognition and management of deteriorating patients across the healthcare system. This has been achieved by adopting the use of the National Early Warning System (NEWS) in prehospital care to standardise communication and building system-wide commitment to improving timely and appropriate transfer of patients.

The combination of regional collaboration, adoption of NEWS by all acute trusts, adaptation of the ambulance electronic record system and redesign of pathways means patients are assessed, transferred and triaged more effectively and efficiently. The region is now a positive outlier for sepsis outcomes.

* Please describe the actions you took to achieve your result.

Using the Institute for Healthcare Improvement breakthrough collaborative model starting in March 2015, teams from across the healthcare system joined to improve the detection and transfer of deteriorating patients from the community into secondary care.

A whole system collaborative was complimented by emergency department and primary care collaboratives and coaching in QI methodologies. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) evaluated the project using quantitative and qualitative research

Significant outputs were: AHSN

• Developed resources for member organisations such as educational posters, prompt cards, patient stories and videos

• Convened meetings and shared learning Acute trusts

• All six acute trusts standardised to NEWS and implemented ED Checklist

• As 2 trusts changed from an existing EWS to NEWS, they developed a toolkit to aid introduction of NEWS into pre-hospital settings.

• The regional neurosurgery centre developed a Neuro NEWS chart now used in neurology and neurosurgical areas. Community

• NEWS is now used across all community health services in the WEAHSN region

• NEWS is requested at point of GP referral into both acute trusts in Bristol supporting triage and treatment escalation during transfer

• Gloucestershire single point of access implemented a standardised referral form which includes NEWS

• Gloucestershire community services conducted a pilot in 3 care homes where NEWS was used combined with care by the rapid response team. This reduced hospital admissions by 26 patients in 3 months

• NEWS teaching is being rolled out to care homes

• NEWS has been introduced into prison services Mental Health

• NEWS has been implemented in community and in-patient mental health services

• A non-contact observation policy has been developed for patients who are non-compliant physical observations Ambulance Service

• NEWS was introduced into the electronic patient clinical record system in the South Western Ambulance Service (SWAST)

• This has been gradually rolled-out over seven counties serving a population of 5.3 million

• The call handler script is currently being updated to enable NEWS to be recorded at handover of care from health professionals Patient and public involvement

• Patient contributors attended all key meetings and collaborative events

• Produced a patient story video incorporating an interview with a patient who benefitted from the use of NEWS

• Patients have been included in the qualitative analysis

• We are currently working with a patient with recurrent sepsis who was taught how to calculate his own NEWS score which has reduced number and length of hospital admissions.

 * Please list the most significant results

 • A systematic review of EWS in prehospital care has shown that there is no previous published study where EWS has been used across a healthcare system to improve outcomes

• Qualitative analysis demonstrated that NEWS across the system was a useful tool for handover, prioritisation and as an adjunct to clinical practice

• The WEAHSN is a positive outlier for mortality in patients with suspicion of sepsis compared to national average with a reduction since 2015.

• A descriptive analysis of NEWS across the healthcare system suggests a NEWS of 5 or more occurs in less than 15% of urgent and emergency patients.

 * Describe how your project has spread to other teams, departments or organisations

The measurement strategy was defined at the outset with the WEAHSN providing expert advice and upskilling staff in QI methodology and evaluation. Forming collaborations in workstreams brought together interested parties from a wide geographical area to share and test ideas and adopt and spread learning.

Having surpassed the original project scope, focus is now on improving the use of NEWS in primary care and care homes to improve recognition and early management of deteriorating patients in conjunction with treatment escalation plans. We are also working with academics and innovators to evaluate novel use of wearable technology to further enable adoption.