Page 9 - HTA REPORT: NATIONAL EARLY WARNING SCORE

Objectives

i. To assess the effectiveness and safety of NEWS in timely detection of patient’s xi
clinical deterioration by evaluating its predictive ability and impact on patient’s clinical
outcomes
ii. To determine the economic implications of a nationally implemented Early Warning
Score system
iii. To evaluate the organisational, ethical, legal and social implications of NEWS
implementation

Research Questions

i. How effective and safe is NEWS as a clinical decision support tools, in predicting HEALTH TECHNOLOGY ASSESSMENT REPORT HEALTH TECHNOLOGY ASSESSMENT SECTION (MaHTAS) MEDICAL DEVELOPMENT DIVISION, MINISTRY OF HEALTH
patient’s clinical deterioration?
ii. What is the estimated economic impact of NEWS implementation in minimizing
occurrence of adverse events and preventable hospital mortality?
iii. What are the organisational, ethical, legal and social issues related to NEWS
implementation?

Methods

Electronic databases were searched for published literatures pertaining to NEWS. The
following electronic databases were searched through the Ovid interface: Ovid MEDLINE ® NATIONAL EARLY
In-process and other Non-indexed citations and Ovid MEDLINE ® 1946 to September
9, 2019, EBM Reviews - Cochrane Central Register of Controlled Trials – August 2019, WARNING SCORE (NEWS)
EBM Reviews - Cochrane Database of Systematic Reviews - 2005 to September 5, 2019,
EBM Reviews - Health Technology Assessment – 4 th Quarter 2016, EBM Reviews – NHS
Economic Evaluation Database 1 st Quarter 2016. Searches were also run in PubMed and
CINAHL. Google was used to search for additional web-based materials and information.
No limits were applied. Additional articles were identified from reviewing the references
of retrieved articles. The search strategies used in the major databases are provided in
Appendix 1. The searches were undertaken on 3 April 2019 and 13 August 2019 using the

same strategies. Supplementary searches were undertaken between 21 May 2019 and 13
August 2019. Last search was conducted on 9 September 2019.

Results and Conclusion

A total of 3084 records were identified through the Ovid interface, PubMed and CINAHL
databases. Additional 25 articles were identified from references of retrieved articles. After
removal of 1407 irrelevant and duplicate articles, 1677 tittles were screened. Of these, 114
relevant abstracts were retrieved in full text. After reading, appraising and applying the
inclusion and exclusion criteria, 79 full text articles were included for qualitative synthesis.
A total of 35 full text articles were excluded due to irrelevant study design (n=5), irrelevant
population (n=11), irrelevant outcome measure(s) (n=7), validation study of other models
(8), master degree dissertation of quality improvement (n=3) and no full text article
in English (n=1). The 79 full text articles comprised of one HTA, two systematic review,
seven randomised control trials (RCTs), 51 cohort studies, one case-control, four pre-post
intervention studies, three audit survey/cross-sectional studies, seven qualitative study
and three economic evaluation studies.