Unplanned transfers from wards to intensive care units: how well does NEWS identify patients in need of urgent escalation of care?

Background: The National Early Warning Score (NEWS) is implemented internationally for in-hospital monitoring. It has been superior to other predictive scores, but its preventive abilities are still unclear. Additionally, data on patients who experience critical events but are not identified by NEWS as being at risk are scarce. We aimed to explore the National Early Warning Score (NEWS) as an actionable trigger to flag high-risk patients for unplanned transfers from a ward to an intensive care unit (ICU).

Methods: Single-centre, retrospective study with case record reviews of all adult, unplanned ICU admissions from a ward to an ICU (level 2 and/ or level 3 ICU) for one year in a Norwegian, 200-bed, urban hospital. We examined the portion of patients flagged by a NEWS of five or seven within 24 h of an ICU transfer, if there was a change in NEWS from the previous 48 h, and how NEWS findings in this patient population differed from a general ward population.

Results: Among 264 unplanned transfers from a ward to an ICU, 164 (62%) and 121 (46%) were flagged by a NEWS of five or seven, respectively. Up to 31% had a change in their NEWS, crossing the five-threshold from the previous 48 h. In contrast, nearly one in five (2077 of 11,310) of all adult admissions to the wards had at least one NEWS of five or higher, though with large variations between departments.

Conclusion: NEWS did not predictably identify patients who were urgently transferred to an ICU from a ward. Less than one-third could have been identified by a recent change in their NEWS, and more than one-third did not meet the criteria of a moderately high NEWS (of five). In addition, a large portion of the ward population have NEWS of five or higher during their hospital stay. Our study emphasizes the vital role of clinical judgment in interaction with early warning scores.