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Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England
  1. Emer Brangan1,2,
  2. Jonathan Banks1,2,
  3. Heather Brant1,2,
  4. Anne Pullyblank3,4,
  5. Hein Le Roux3,5,
  6. Sabi Redwood1,2
  1. 1 The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  2. 2 Population Health Sciences, University of Bristol Medical School, Bristol, UK
  3. 3 Patient Safety Collaborative, West of England Academic Health Science Network, Bristol, UK
  4. 4 General Surgery, North Bristol NHS Trust, Bristol, UK
  5. 5 Governing Body, NHS Gloucestershire Clinical Commissioning Group, Brockworth, UK
  1. Correspondence to Dr Emer Brangan; e.brangan{at}


Objectives Early warning scores were developed to improve recognition of clinical deterioration in acute hospital settings. In England, the National Early Warning Score (NEWS) is increasingly being recommended at a national level for use outside such settings. In 2015, the West of England Academic Health Science Network supported the roll-out of NEWS across a range of non-acute-hospital healthcare sectors. Research on the use of NEWS outside acute hospitals is limited. The objective of this study was to explore staff experiences of using NEWS in these new settings.

Design Thematic analysis of qualitative semi-structured interviews with purposefully sampled healthcare staff.

Setting West of England healthcare settings where NEWS was being used outside acute hospitals—primary care, ambulance, referral management, community and mental health services.

Participants Twenty-five healthcare staff interviewed from primary care (9), ambulance (3), referral management/acute interface (5), community (4) and mental health services (3), and service commissioning (1).

Results Participants reported that NEWS could support clinical decision-making around escalation of care, and provide a clear means of communicating clinical acuity between clinicians and across different healthcare organisations. Challenges with implementing NEWS varied—in primary care, clinicians had to select patients for NEWS and adopt different methods of clinical assessment, whereas for paramedics it fitted well with usual clinical practice and was used for all patients. In community services and mental health, modifications were ‘needed’ to make the tool relevant to some patient populations.

Conclusions This study demonstrated that while NEWS can work for staff outside acute hospital settings, the potential for routine clinical practice to accommodate NEWS in such settings varied. A tailored approach to implementation in different settings, incorporating guidance supported by further research on the use of NEWS with specific patient groups in community settings, may be beneficial, and enhance staff confidence in the tool.

  • qualitative research
  • primary care
  • mental health

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  • EB and JB are joint first authors.

  • Contributors AP, SR and JB conceived the study. EB and JB generated the data and drafted the original manuscript. EB and HB analysed the data with guidance from JB and SR. HLR, SR, AP, HB, JB and EB contributed to the interpretation of findings and revisions to the manuscript. All authors approved the final version of the manuscript.

  • Funding This work was jointly funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust and the West of England Academic Health Science Network. NIHR CLAHRC West (University Hospitals Bristol NHS Foundation Trust) received support from the West of England Academic Health Sciences Network which part funded the work.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of NHS England, NHS Improvement, the NIHR or the Department of Health and Social Care.

  • Patient consent Not required.

  • Ethics approval Approved by the University of Bristol Faculty of Health Sciences Research Ethics Committee (Application number 38181) and the Health Research Authority (IRAS project ID 214672, protocol number 2677).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised interview transcripts are available for use by bona fide researchers subject to assessment of requests by the University of Bristol Research data service DOI: 10.5523/bris.jh9lbeb3f1ng27m9ykk3dti9p

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