Pinderfields ED improves timeliness of NEWS2 recording | MY staff stories

The Emergency Department team at Pinderfields have been applying the Improving Together methodology to identify their own opportunities for quick wins. Through this work, the team highlighted the importance of early identification of patient deterioration within the Emergency Department.

Early recognition of deteriorating patients is critical in ED. The team identified that improving how quickly National Early Warning Score 2 (NEWS2) scores are recorded on the electronic system would allow the sickest patients to be clearly identified and prioritised without delay.

Although observations were being taken promptly, NEWS2 scores were often recorded on paper initially and entered onto the electronic system later in the day. 

The team focused on the critical period between ambulance handover and the first NEWS2 score being recorded. 

As a first quick win, immediate access to a computer was provided so that NEWS2 scores could be entered directly onto the electronic system at the time observations were taken. The team trialled recording NEWS2 digitally straight after patient review, rather than waiting until later in the pathway. Early results from this change were significant showing:

• Faster clinical interventions for deteriorating patients
• Improved accuracy and timeliness of data
• Better real-time oversight of patient acuity
• A measurable reduction in patient deterioration, even during periods of increased ambulance arrivals 

Performance improved from an average of 17% in the six weeks prior to testing, to 25% following the introduction of real-time NEWS2 recording.

Following this initial testing, the ED team identified a further opportunity to improve the process. 

Previously, colleagues were having to find available space to carry out initial observations, which led to delays for both patients and staff.

Through Improvement huddles and ideas from the team, Initial Assessment Cubicles (IAT cubicles) were identified, clearly labelled, and the change was communicated to staff.

The introduction of dedicated IAT cubicles led to a further improvement, with performance increasing to 34% of patients having their first NEWS2 score recorded directly onto the system.

The introduction of IAT cubicles, alongside improved access to equipment and systems, has had a significant positive impact on achieving NEWS2 scores within 15 minutes of ambulance handover. This has enabled earlier identification of the most unwell patients and supported more timely ambulance turnaround, representing a major step change in performance within a short testing period.

This has supported safer decision-making, better prioritisation, and an improved experience for both patients and staff in the Emergency Department.