National Early Warning Scores Following Emergency Hospital Transfer: Implications for Care Home Residents

Objective: Care home residents have high rates of hospital admission. The UK National Early Warning Score (NEWS2) standardizes the secondary care response to acute illness. However, the ability of NEWS2 to predict adverse health outcomes specifically for care home residents is unknown. This study explored the relationship between NEWS2 on admission to hospital and resident outcome 7 days later. Design: Repeated cross-sectional study. Setting and Participants: Data on UK care home residents admitted to 160 hospitals in two 24-hour periods (2019 and 2020). Method: Chi-squared and Kruskal-Wallis tests, and multinomial regression were used to explore the association between low (score <2), intermediate (3-4), high (5-6), and critically high (>= 7) NEWS2 on admission and each of the following: discharge on day of admission, admission and discharge within 7 days, prolonged hospital admission (>7 days), and death. Results: From 665 resident admissions across 160 hospital sites, NEWS2 was low for 54%, intermediate for 18%, high for 13%, and critically high for 16%. The 7-day outcome was 10% same-day discharge, 47% admitted and subsequently discharged, 34% remained inpatients, and 8% died. There is a significant association between NEWS2 and these outcomes (P < .001). Compared with those with low NEWS2, residents with high and critically high NEWS2 had 3.6 and 9.5 times increased risk of prolonged hospitalization [relative risk ratio (RRR) 3.56; 95% CI 1.02-12.37; RRR 9.47; CI 2.20-40.67], respectively. The risk of death was approximately 14 times higher for residents with high NEWS2 (RRR 13.62; CI 3.17 -58.49) and 54 times higher (RRR 53.50; CI 11.03-259.54) for critically high NEWS2.