Background
• staff "...rarely carry out routine observations during the night
"...observations are seen as tasks with a low priority..."
National Patient Safety Agency (2007) Recognising and responding appropriately to early
signs of deterioration in hospitalised patients. NPSA, London.
• physiological observations should be monitored at least every 12 hours
with the frequency increasing if abnormal physiology was detected.
National Institute for Health and Clinical Excellence. NICE clinical guideline 50 Acutely ill
patients in hospital: recognition of and response to acute illness in adults in hospital. London,
National Institute for Health and Clinical Excellence, 2007.
Path
labs
DBS
Server
PAS
DBS







Heart rate
Blood pressure
Respiratory rate
Oxygen saturation
Temperature
Conscious level
Inspired oxygen
 Other data
ViEWS (VitalPAC™ Early Warning Score)
YES
111 – 249
> 250
< 40
Prytherch et al. Resuscitation 2010; 81: 932–937
National Early Warning Score (NEWS)
Royal College of Physicians of London, 2012
•
•
•
•
•
NEWS adopted by 1/3 rd English hospitals
Further 1/3rd state intention to adopt
NEWS nationwide Wales
ViEWS nationwide Ireland
Currently being trialled in Denmark and Holland.
• ViEWS externally validated US, Canada, Uganda
Papers 2010-13
•
Carr E, Meredith P, Chumbley G, Killen R, Prytherch DR, Smith GB. Pain during admission to a United Kingdom District
General Hospital. Should pain be a patient safety issue? Journal of Advanced Nursing 2013 in press.
Hands C, Reid E, Meredith P, Smith GB, Prytherch DR, Schmidt PE, Featherstone PI.
Patterns in the recording of vital signs and early warning scores - time of day, day of week.
BMJ Quality & Safety 2013 in press.
Mohammed MA, Rudge G, Watson D, Wood G, Smith GB, Prytherch D, Dirling A, Stevens A.
Index blood tests and national early warning scores within 24 hours of emergency admission can predict the risk of
in-hospital mortality: a model development and validation study. PLoS ONE 2013 in press
Smith GB, Prytherch DR, Meredith P, Schmidt PE, Featherstone PI. The ability of the National Early Warning Score
(NEWS) to discriminate patients at risk of early cardiac arrest, unanticipated intensive care unit admission, and
death Resuscitation 2013;84:465-470.
Mohammed MA, Rudge G, Wood G, Smith GB, Nangalia V, Prytherch D, Holder R, Briggs J. Which is more useful in
predicting hospital mortality - dichotomised blood test results or actual test values? A retrospective study in two
hospitals. PLoS ONE 2012 7(10): e46860. doi:10.1371/journal.pone.0046860
Smith GB, Prytherch DR, Watson D, Forde V, Windsor A, Schmidt PE, Featherstone PI, Higgins B, Meredith P. SpO2 values in
acute medical admissions breathing air – implications for the British Thoracic Society guideline for emergency
oxygen use in adult patients? Resuscitation 2012; 83: 1201-1205
Nangalia V, Prythrech DR, Smith GB. Health technology assessment review: Remote monitoring of vital signs – current
status and future challenges. Critical Care 2010; 14: 233
Prytherch D, Smith GB, Schmidt PE, Featherstone PI. ViEWS - towards a national Early Warning Score for detecting
adult inpatient deterioration. Resuscitation 2010; 81: 932–937.
Items Submitted for publication
• Badriyah T, Briggs JS, Meredith P, Schmidt PE, Featherstone PI, Prytherch DR, Smith GB.
Decision-tree early warning score (DTEWS) validates the design characteristics of the
National Early Warning Score (NEWS). Submitted to Resuscitation.
• Jarvis SJ, Kovacs C, Badriyah T, Briggs JS, Mohammed MA, Meredith P, Schmidt PE,
Featherstone PI, Prytherch DR, Smith GB. Development and validation of a decision-tree
early warning score based on routine laboratory result tests for the discrimination of
hospital mortality. Submitted to Resuscitation.
Future work