A combined research team from the University of Portsmouth, Portsmouth Hospitals University NHS Trust and Bournemouth University has shown that an assessment score used to measure a patient’s severity of illness can be applied to patients with Covid-19 without modification.
The Portsmouth Academic Consortium For Investigating Covid-19 (PACIFIC-19) team, including Professor Gary B Smith from Bournemouth University, has shown that the National Early Warning Score (NEWS) is equally good at predicting certain adverse clinical outcomes in patients with Covid-19 and other groups of patients admitted to hospital.
These results are important because they show that different techniques are not required for monitoring the severity of illness of patients with Covid-19. Developing new ways of working would require investment, take time and lead to extra demands on staff training, at a time when these are in short supply.
NEWS is used across the NHS to measure a patient’s severity of illness. It takes commonly measured vital sign readings (pulse, blood pressure, temperature, breathing rate, etc.) and converts them to a single value from 0 to 20. The higher the NEWS value the greater the patient’s risk of developing certain adverse clinical outcomes.
The original work underpinning NEWS started in Portsmouth about 14 years ago. Since then, NEWS has been recommended by the Royal College of Physicians and NHS England. More recently, the World Health Organisation (WHO) has recommended its use for the close monitoring of clinical deterioration in patients with Covid-19.
In a separate study, the PACIFIC-19 team was also able to show that the Covid-19 outbreak, and the processes required to respond to it, did not adversely affect the ability of healthcare staff to monitor the vital signs of patients under their care.
Professor Smith, Visiting Professor at the Centre of Postgraduate Medical Research & Education (CoPMRE) at Bournemouth University, said, “Regularly monitoring a patient’s vital signs and evaluating their abnormality are crucial to detecting patient deterioration and directing clinical care. In our first study, we compared the performance of NEWS in hospital in-patients from 2020 who had a positive Covid-19 test with four control groups, including two from before the Covid-19 pandemic. We showed that the performance of NEWS was similar in each group, which shows that amendments to NEWS are unnecessary when evaluating and monitoring the sickness of patients with Covid-19. This is important because modifications to NEWS would also require changes to patient vital signs documents and staff training across the NHS, which would entail investment and take time when these are in short supply.
Professor Smith continued, “The aim of the second study was to investigate if and how the burdens of the initial phase of the Covid-19 pandemic, and the altered healthcare structures and processes required to respond to it, affected the patterns of vital signs and NEWS recording in the hospital. In response to the pandemic, staff worked modified shift patterns, sometimes in unfamiliar clinical settings, and much of the clinical work, including the measurement of patients’ vital signs, was undertaken with staff wearing personal protective equipment (PPE) such as gowns, gloves, masks and face visors. However, overall, we could find no evidence that the Covid-19 pandemic affected the pattern of vital signs collection. In fact, some evidence suggested improved adherence to vital signs monitoring protocols. These findings are important as they demonstrate that the crucial aspects of patient monitoring were not affected by the increased burdens of the Covid-19 pandemic and the necessary changes to healthcare delivery.”
The results of both studies are published in the international journal, Resuscitation, and were presented at an online conference earlier this month, attended by over 1,000 people from across the NHS.