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M28 From NEWS to CREWS: The chronic respiratory early warning score for patients with chronic hypoxaemia
  1. SR Eccles1,
  2. C Subbe2,
  3. D Hancock3,
  4. N Thompson3
  1. 1Wrexham Maelor Hospital, Wrexham, Wales
  2. 2Ysbyty Gwynedd, Bangor, Wales
  3. 3Cardiff University School of Medicine, Cardiff, Wales3

Abstract

Introduction In patients with respiratory conditions associated with chronic hypoxaemia such as COPD, use of the National Early Warning Score (NEWS)[1] leads to a high number of triggers. We designed a simple variant of NEWS for patients with chronic hypoxaemia.

Methods Data was collected from respiratory wards at two hospitals in North Wales over a three-month period. Patients were categorised into those with chronic hypoxaemia (CH, target oxygen saturations 88–92%) and others (O, target saturations 94–98%). Vital signs were recorded on admission to hospital, at the peak NEWS score during admission, and during a period of stability/at discharge.

Results 196 admissions were included in the analysis. 98 (50%) were male, 91 had COPD, 26 received long-term oxygen therapy. Mean age was 70 (range 19–102). 78 patients had target saturations of 88–92% (CH patients). The mean NEWS for all patients on admission was 5 (SD 3), mean peak NEWS was 7 (SD 3), and median hospital length of stay was 10 days (IQR 6:17).

23 patients died within 30 days; 12 with CH. Of these, all patients with CH scored 6 + using NEWS compared to 9/11 O patients. When stable/at discharge, 32% of CH patients scored 6 + using NEWS (Welsh trigger) and 50% scored 5 + (RCP trigger). By using a recalibrated scoring system (CREWS, table 1), patients triggering during stability/at discharge were reduced to 14% (5 + trigger) and 8% (6 + trigger). All patients who subsequently died still triggered at peak CREWS scores.

Abstract M28 Table 1.

Scores allocated for oxygen saturations (%) for NEWS, and for CREWS for CH patients.

Conclusion Patients with chronic respiratory conditions have altered baseline parameters that lead to a high number of NEWS triggers. CREWS reduces triggers, which may reduce unnecessary reviews and alarm fatigue, without compromising safety.

Reference

  1. Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acute illness severity in the NHS. Report of a working party. London: RCP, 2012.

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