Page 8 - HTA REPORT: NATIONAL EARLY WARNING SCORE

EXECUTIVE

SUMMARY
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Background

Reduction in the incidence of hospital adverse events and the number of preventable
deaths in hospital has been the major focus of many quality improvement initiatives
worldwide. It is a reflection on the capacity of the healthcare service in delivering high
quality care to the patients. ‘Catastrophic’ medical or sentinel events which include in-
hospital cardiopulmonary arrests and deterioration in the patient’s clinical condition are
often preceded by a steady accumulation of small clinical clues or a period of abnormal
physiological status of the patient. In numerous studies, this abnormality was reflected
on recorded patient’s vital signs (blood pressure, heart rate, respiratory rate and
temperature) suggesting that potential serious complications or adverse events in patient
outcomes can be avoided if they were anticipated early. Recording patient’s physiological
observations is considered part of daily routine management in hospital either in acute
hospital setting like in emergency department or in general ward setting. It is currently
WARNING SCORE (NEWS)
NATIONAL EARLY
based mostly on intermittent measurements of basic parameters; blood pressure, heart
rate, temperature and oxygen saturation by nursing staffs. Several hours can pass between
such measurements and patient deterioration can go unnoticed especially on busy wards
or during the night. Early Warning Scores (EWSs) are clinical bedside decision support
tools used by care teams to potentially predict a patient’s risk of deterioration and
facilitate changes in management. Currently, it has been implemented across a variety of
specialties and international settings.

At present, there has not been a formal adoption of single standardised EWS at national
level that can be used across Malaysian healthcare system. While the few have adopted
EWS either in its original version or adapted versions, tailored to their personalised hospital
needs, majority of local hospitals are still using a conventional observation chart with
routine four basic vital signs monitoring. Consistent use of a single nationally agreed EWS
system as a tool for detection and response to clinical deterioration in adult patients will
HEALTH TECHNOLOGY ASSESSMENT REPORT
HEALTH TECHNOLOGY ASSESSMENT SECTION (MaHTAS)
MEDICAL DEVELOPMENT DIVISION, MINISTRY OF HEALTH
ensure that all patients are objectively assessed in the same way, regardless of the clinical
expertise of the clinician or where the patient is assessed. This will ensure that the severity
of illness and the rate of deterioration can be explicitly stated and understood throughout
the entire Malaysian healthcare system. Hence, this Health Technology Assessment
(HTA) was requested by Head of Department and Senior Consultant of General Surgery
from Kuala Krai Hospital, Kelantan, to assess the effectiveness, safety, economic and
organisational impacts of National Early Warning Score (NEWS) as standardised approach
for the detection of and response to clinical deterioration in patients with acute illness.

Technical features

The NEWS is based on an aggregate scoring system in which a score is allocated to
physiological measurements. Six simple physiological parameters form the basis of the
scoring system: i) Respiratory rate ii) Oxygen saturations iii) Temperature iv) Systolic blood
pressure v) Pulse rate vi) Level of consciousness. A score is allocated to each as they are
measured, the magnitude of the score reflecting how extreme the parameter varies from
the norm. The individual scores are then combined. Depending on the total score, the
escalation of care is linked to recommendations on the frequency of observations and the
urgency of clinical review.

Policy Question

Should National Early Warning Score (NEWS) be implemented in Ministry of Health (MOH)
hospitals to improve safety, efficiency and standardisation of patient care?