Using the National Early Warning Score (NEWS/NEWS 2) in different Intensive Care Units (ICUs) to predict the discharge location of patients.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968562 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2458 (Electronic) Linking ISSN: 14712458 NLM ISO Abbreviation: BMC Public Health Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Early Warning Score* ; Intensive Care Units*; Patient Discharge/*statistics & numerical data; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; United Kingdom ; Young Adult

Background: The National Early Warning Score (NEWS/NEWS 2) has been adopted across the National Health Service (NHS) in the U.K. as a method of escalating care for deteriorating patients. Intensive Care Unit (ICU) resources are limited and in high demand, with patient discharge a focal point for managing resources effectively. There are currently no universally accepted methods for assessing discharge of patients from an ICU, which can cause premature discharges and put patients at risk of subsequent deterioration, readmission to ICU or death.
Methods: We tested the ability of the NEWS to discriminate patients within 24h of admission to an ICU in a U.S. hospital during 2001-2012, by their end discharge location: home; hospital ward; nursing facility; hospice and death. The NEWS performance was compared across five different ICU specialties, using the area under the receiver operating characteristic (AUROC) curve and a large vital signs database (n=2,723,055) collected from 28,523 critical care admissions.
Results: The NEWS AUROC (95% CI) at 24h following admission: all patients 0.727 (0.709-0.745); Coronary Care Unit (CCU) 0.829 (0.821-0.837); Cardiac Surgery Recovery Unit (CSRU) 0.844 (0.838-0.850); Medical Intensive Care Unit (MICU) 0.778 (0.767-0.791); Surgical Intensive Care Unit (SICU) 0.775 (0.762-0.788); Trauma Surgical Intensive Care Unit (TSICU) 0.765 (0.751-0.773).
Conclusions: The NEWS has reasonable discrimination for any ICU patient's discharge location. The NEWS has greater ability to discriminate patients in the Coronary Care Unit (CCU) and Cardiac Surgery Recovery Unit (CSRU) compared to other ICU specialties. The NEWS has the real potential to be applied within a universal discharge planning tool for ICU, improving patient safety at the point of discharge.

BMJ. 2001 May 26;322(7297):1274-6. (PMID: 11375229)
Intensive Care Med. 2001 Sep;27(9):1441-5. (PMID: 11685336)
Curr Opin Crit Care. 2001 Dec;7(6):480-4. (PMID: 11805556)
Intensive Crit Care Nurs. 2002 Apr;18(2):90-5. (PMID: 12353656)
BMJ. 2003 Nov 1;327(7422):1014. (PMID: 14593033)
J Crit Care. 2003 Dec;18(4):206-11. (PMID: 14691893)
Aust Health Rev. 2004;28(1):87-96. (PMID: 15525255)
Anaesth Intensive Care. 2004 Oct;32(5):697-701. (PMID: 15535498)
Intensive Crit Care Nurs. 2005 Feb;21(1):39-46. (PMID: 15681216)
Qual Saf Health Care. 2005 Apr;14(2):130-4. (PMID: 15805459)
Chest. 2005 Jun;127(6):2165-79. (PMID: 15947334)
Intensive Care Med. 2005 Dec;31(12):1676-82. (PMID: 16249927)
Anaesth Intensive Care. 2006 Feb;34(1):55-60. (PMID: 16494151)
Med J Aust. 2006 Apr 3;184(7):334-7. (PMID: 16584367)
Aust Crit Care. 2009 Feb;22(1):29-43. (PMID: 19138531)
Resuscitation. 2010 Aug;81(8):932-7. (PMID: 20637974)
PLoS One. 2012;7(11):e48758. (PMID: 23144958)
Sci Data. 2016 May 24;3:160035. (PMID: 27219127)
Sci Data. 2018 Sep 11;5:180178. (PMID: 30204154)
Biometrics. 1988 Sep;44(3):837-45. (PMID: 3203132)

Keywords: Decision making; Discharge location; Intensive care unit; National early warning score; Outcome prediction; Patient discharge; Patient outcomes; Vital signs

Date Created: 20190907 Date Completed: 20191206 Latest Revision: 20200225

20240105

PMC6729008

10.1186/s12889-019-7541-3

31488143