The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals

dc.check.date2020-03-01
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisher.en
dc.contributor.authorMohammed, Mohammed A.
dc.contributor.authorFaisal, Muhammad
dc.contributor.authorRichardson, Donald
dc.contributor.authorScally, Andrew
dc.contributor.authorHowes, Robin
dc.contributor.authorBeatson, Kevin
dc.contributor.authorIrwin, Sally
dc.contributor.authorSpeed, Kevin
dc.contributor.funderNational Institute for Health Researchen
dc.contributor.funderHealth Foundation, United Kingdomen
dc.date.accessioned2019-03-21T13:12:42Z
dc.date.available2019-03-21T13:12:42Z
dc.date.issued2019-03-01
dc.date.updated2019-03-21T13:02:25Z
dc.description.abstractBackground: The National Early Warning Score (NEWS) is being replaced with NEWS2 which adds 3 points for new confusion or delirium. We estimated the impact of adding delirium on the number of medium/high level alerts that are triggers to escalate care. Methods: Analysis of emergency medical admissions in two acute hospitals (York Hospital (YH) and Northern Lincolnshire and Goole NHS Foundation Trust hospitals (NH)) in England. Twenty per cent were randomly assigned to have delirium. Results: The number of emergency admissions (YH: 35584; NH: 35795), mortality (YH: 5.7%; NH: 5.5%), index NEWS (YH: 2.5; NH: 2.1) and numbers of NEWS recorded (YH: 879193; NH: 884072) were similar in each hospital. The mean number of patients with medium level alerts per day increased from 55.3 (NEWS) to 69.5 (NEWS2), a 25.7% increase in YH and 64.1 (NEWS) to 77.4 (NEWS2), a 20.7% increase in NH. The mean number of patients with high level alerts per day increased from 27.3 (NEWS) to 34.4 (NEWS2), a 26.0% increase in YH and 29.9 (NEWS) to 37.7 (NEWS2), a 26.1% increase in NH. Conclusions: The addition of delirium in NEWS2 will have a substantial increase in medium and high level alerts in hospitalised emergency medical patients. Rigorous evaluation of NEWS2 is required before widespread implementation because the extent to which staff can cope with this increase without adverse consequences remains unknown.en
dc.description.sponsorshipNational Institute for Health Research (Yorkshire and Humber Patient Safety Translational Research Centre)en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationMohammed, M. A., Faisal, M., Richardson, D., Scally, A., Howes, R., Beatson, K., Irwin, S. and Speed, K. (2019) 'The inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitals', Clinical Medicine, 19(2), pp. 104-108. Available at: http://www.clinmed.rcpjournal.org/content/19/2/104 (Accessed: 21 March 2019)en
dc.identifier.endpage108en
dc.identifier.issn1470-2118
dc.identifier.issn1473-4893
dc.identifier.issued2en
dc.identifier.journaltitleClinical Medicineen
dc.identifier.startpage104en
dc.identifier.urihttps://hdl.handle.net/10468/7655
dc.identifier.volume19en
dc.language.isoenen
dc.publisherRoyal College of Physiciansen
dc.relation.urihttp://www.clinmed.rcpjournal.org/content/19/2/104
dc.rights© 2019, Royal College of Physicians. All rights reserved.en
dc.subjectNational Early Warning Scoreen
dc.subjectNEWS2en
dc.subjectDeliriumen
dc.subjectAlerten
dc.subjectEscalationen
dc.titleThe inclusion of delirium in version 2 of the National Early Warning Score will substantially increase the alerts for escalating levels of care: findings from a retrospective database study of emergency medical admissions in two hospitalsen
dc.typeArticle (peer-reviewed)en
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