Introduktion: Minskat antal vårdplatser och en ökad ålder på befolkningen gör att trycket på vården ökar. I takt med detta ökar också risken för att patientsäkerheten inte kan upprätthållas. NEWS är ett bedömnings- och screeninginstrument var syfte är att öka patientsäkerheten genom att standardisera bedömningar av vitala parametrar för att effektivt kunna förhindra kritiska tillstånd. Sjuksköterskor kan använda NEWS tillsammans med sin kliniska bedömning för att utföra en adekvat bedömning av patienters aktuella hälsotillstånd. Syfte: Litteraturstudiens syfte var att undersöka sjuksköterskors erfarenhet av att använda National Early Warning Score som bedömningsinstrument för att bedöma patienters hälsostatus. Metod: Litteraturstudien bygger på Polit och Becks (2017) nio steg med induktiv ansats. Relevanta sökord mot syftet identifierades och systematiska artikelsökningar genomfördes i Cinahl och PubMed. Sökningarna resulterade i 11 artiklar relevanta för studien som kvalitetsgranskades utifrån Polit och Becks (2017) granskningsmallar. I databearbetningen framkom tre teman. Resultat: Tre teman framkom utifrån sjuksköterskors erfarenhet av att använda NEWS som bedömningsinstrument för att bedöma patienters hälsostatus, dessa var NEWS som stöd och hinder i klinisk bedömning, NEWS påverkan på arbetsbelastningen, samt hur sjuksköterskors utbildning och yrkeserfarenhet kunde kombineras med NEWS. Resultatet visade att NEWS är ett bra stöd till sjuksköterskors kliniska bedömning. Detta stödjer främst sjuksköterskor med kortare erfarenhet, men kan ändå vara ett bra stöd till sjuksköterskor med längre erfarenhet. Slutsats: Erfarna sjuksköterskor ansåg att sjuksköterskor med kortare erfarenhet än de själva kan behöva stöd i sin kliniska helhetsbedömning samt kommunikation, och då är NEWS ett bra komplement. Sjuksköterskorna i litteraturstudien var inte enade om arbetsbelastningen ökade eller inte vid användandet av NEWS.

Bakgrund: Sepsis som i vardagligt tal benämns blodförgiftning är ett allvarligt tillstånd och uppstår när kroppens immunsystem överreagerar på en infektion. Är de metabola och cirkulatoriska förändringarna påtagligt förhöjda i kombination med organdysfunktion benämns tillståndet som septisk chock. Tidig identifikation har en betydande roll för patientens överlevnad och livskvalité. Sjuksköterskan arbetar patientnära och med rätt förutsättningar möjliggörs tidig identifikation. Syfte: Syftet är att belysa sjuksköterskans omvårdnadsåtgärder för tidig upptäckt av sepsis. Metod: Studien utfördes som en litteraturöversikt där både kvalitativa och kvantitativa artiklar användes. Fribergs granskningsmall användes för att granska kvalitén. Resultat: Två huvudteman identifierades; Sjuksköterskans kunskap och Ett gemensamt förhållningssätt som sedan följs av sex subteman; Kunskapsutveckling och sepsisprotokoll, Vikten av praktisk kunskap, Teamsamverkan, Stödjande bedömningsverktyg - NEWS, Vikten av att tala samma språk och Kliniska blicken. Konklusion: Denna litteraturöversikt belyser faktorer som kan inverka på sjuksköterskans möjlighet att identifiera sepsis i tid. Eftersom sepsis är ett vanligt och allvarligt tillstånd är det av betydelse att sjuksköterskor ges möjlighet att öka kompetensen inom området. Eftersom det brister inom hälso- och sjukvården avseende huruvida sepsis upptäcks i tid, bör vidare forskning inom området studeras för att minska patientens lidande och för att minska dödlig utgång. / Background: Sepsis also known as blood poisoning, is a serious condition and occurs when the body's immune system overreacts to an infection. If the metabolic and circulatory changes are significantly increased in combination with organ dysfunction, the condition is called septic shock. Early identification has a significant role for the patient's quality of life and survival. The nurse works close to the patient and with the right conditions early identification is possible. Aim: The aim is to shed light on the nurse´s care measures for early detection of sepsis. Method: The study was conducted as a literature review where both qualitative and quantitative articles were used. Friberg's review template was used to review the quality. Findings: Two main themes were identified; The nurse's knowledge and A joint approach which is then followed by six sub-themes; Knowledge development and sepsis protocols, The importance of practical knowledge, Team collaboration, Supporting assessment tools - NEWS, The importance of speaking the same language and The clinical gaze. Conclusion: This literature review highlights factors that can influence the nurse's ability to identify sepsis in time. As sepsis is a common and serious condition, it is important that nurses are given the opportunity to increase their competence in the area. Since there are deficiencies in the healthcare system regarding whether sepsis is detected in time, further research in the field should be studied to reduce patient suffering and to reduce mortality.

Yes / Hospital-acquired Acute Kidney Injury (H-AKI) is a common cause of avoidable morbidity and mortality. To determine if the patients’ vital signs data as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. Methods: Analyses of emergency admissions to York hospital over 24-months with NEWS data. We report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3). Likewise for maximum NEWS (models B0,B1,B2,B3). Results: 4.05% (1361/33608) of emergency admissions had H-AKI. Models using the index NEWS had the lower AUCs (0.59 to 0.68) than models using the maximum NEWS AUCs (0.75 to 0.77). The maximum NEWS model (B3) was more sensitivity than the index NEWS model (A0) (67.60% vs 19.84%) but identified twice as many cases as being at risk of H-AKI (9581 vs 4099) at a NEWS of 5. Conclusions: The index NEWS is a poor predictor of H-AKI. The maximum NEWS is a better predictor but seems unfeasible because it is only knowable in retrospect and is associated with a substantial increase in workload albeit with improved sensitivity. / The Health Foundation

Yes / Routine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score. Methods: We extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time. Results: Emergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p

Yes / The novel coronavirus SARS-19 produces 'COVID-19' in patients with symptoms. COVID-19 patients admitted to the hospital require early assessment and care including isolation. The National Early Warning Score (NEWS) and its updated version NEWS2 is a simple physiological scoring system used in hospitals, which may be useful in the early identification of COVID-19 patients. We investigate the performance of multiple enhanced NEWS2 models in predicting the risk of COVID-19. Our cohort included unplanned adult medical admissions discharged over 3 months (11 March 2020 to 13 June 2020 ) from two hospitals (YH for model development; SH for external model validation). We used logistic regression to build multiple prediction models for the risk of COVID-19 using the first electronically recorded NEWS2 within ± 24 hours of admission. Model M0' included NEWS2; model M1' included NEWS2 + age + sex, and model M2' extends model M1' with subcomponents of NEWS2 (including diastolic blood pressure + oxygen flow rate + oxygen scale). Model performance was evaluated according to discrimination (c statistic), calibration (graphically), and clinical usefulness at NEWS2 ≥ 5. The prevalence of COVID-19 was higher in SH (11.0 %=277/2520) than YH (8.7 %=343/3924) with a higher first NEWS2 scores ( SH 3.2 vs YH 2.8) but similar in-hospital mortality (SH 8.4 % vs YH 8.2 %). The c-statistics for predicting the risk of COVID-19 for models M0',M1',M2' in the development dataset were: M0': 0.71 (95 %CI 0.68-0.74); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.78 (95 %CI 0.75-0.80)). For the validation datasets the c-statistics were: M0' 0.65 (95 %CI 0.61-0.68); M1': 0.67 (95 %CI 0.64-0.70) and M2': 0.72 (95 %CI 0.69-0.75) ). The calibration slope was similar across all models but Model M2' had the highest sensitivity (M0' 44 % (95 %CI 38-50 %); M1' 53 % (95 %CI 47-59 %) and M2': 57 % (95 %CI 51-63 %)) and specificity (M0' 75 % (95 %CI 73-77 %); M1' 72 % (95 %CI 70-74 %) and M2': 76 % (95 %CI 74-78 %)) for the validation dataset at NEWS2 ≥ 5. Model M2' appears to be reasonably accurate for predicting the risk of COVID-19. It may be clinically useful as an early warning system at the time of admission especially to triage large numbers of unplanned hospital admissions. / The Health Foundation (Award No 7380) and the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC) (Award No PSTRC-2016-006) / Research Development Fund Publication Prize Award winner, Aug 2021.

Introduction: A recent study at the acute admission unit (AAU), revealed that 13.5 percent ofall patients discharged from the department, were readmitted within 30 days during 2018. Inthe group of 80 years and above, the cause for re-admission was multifactorial. Aim: To identify factors that are associated with unplanned re-admission, palliative decision,or death within 30 days after discharge from the AAU, in patients of 80 years or above. Anotheraim is to examine if longer hospital stay, patient discharge planning and fast follow-up canprotect against these outcomes. Methods: A retrospective cohort study comprising 287 patients. Data on age, sex, length ofstay, comorbidities (Elixhauser comorbidity index), frailty (Clinical frailty scale), NationalEarly Warning Score (NEWS), social status, home care, lab values and outcome were collected.All variables were analyzed using Chi-square test with univariate and multivariate logisticregression, and a p-value < 0.05 was considered statistically significant. Results: 276 patients were included. A NEWS ≥ 3 was associated with significantly increasedrisk for poor outcome (odds ratio 2.4). Living with someone without municipal support wasassociated with a significantly decreased risk for poor outcome (odds ratio 0.21). Conclusions: The results indicate that it is crucial to stabilize patients of 80 years or abovebefore discharge. And that living with someone without municipal support is a protective factor.

Yes / Objectives: To develop a logistic regression model to predict the risk of sepsis following emergency medical admission using the patient’s first, routinely collected, electronically recorded vital signs and blood test results and to validate this novel computer-aided risk of sepsis model, using data from another hospital. Design: Cross-sectional model development and external validation study reporting the C-statistic based on a validated optimized algorithm to identify sepsis and severe sepsis (including septic shock) from administrative hospital databases using International Classification of Diseases, 10th Edition, codes. Setting: Two acute hospitals (York Hospital - development data; Northern Lincolnshire and Goole Hospital - external validation data). Patients: Adult emergency medical admissions discharged over a 24-month period with vital signs and blood test results recorded at admission. Interventions: None. Main Results: The prevalence of sepsis and severe sepsis was lower in York Hospital (18.5% = 4,861/2,6247; 5.3% = 1,387/2,6247) than Northern Lincolnshire and Goole Hospital (25.1% = 7,773/30,996; 9.2% = 2,864/30,996). The mortality for sepsis (York Hospital: 14.5% = 704/4,861; Northern Lincolnshire and Goole Hospital: 11.6% = 899/7,773) was lower than the mortality for severe sepsis (York Hospital: 29.0% = 402/1,387; Northern Lincolnshire and Goole Hospital: 21.4% = 612/2,864). The C-statistic for computer-aided risk of sepsis in York Hospital (all sepsis 0.78; sepsis: 0.73; severe sepsis: 0.80) was similar in an external hospital setting (Northern Lincolnshire and Goole Hospital: all sepsis 0.79; sepsis: 0.70; severe sepsis: 0.81). A cutoff value of 0.2 gives reasonable performance. Conclusions: We have developed a novel, externally validated computer-aided risk of sepsis, with reasonably good performance for estimating the risk of sepsis for emergency medical admissions using the patient’s first, electronically recorded, vital signs and blood tests results. Since computer-aided risk of sepsis places no additional data collection burden on clinicians and is automated, it may now be carefully introduced and evaluated in hospitals with sufficient informatics infrastructure. / Health Foundation

Abstract Emergency medical services (EMS) are designed to provide prompt response, on-scene treatment and transport for definitive care in patients with acute illness or injury. In recent years, the growing number of missions for non-urgent matters has challenged emergency care to design risk assessment protocols and tools to support decision-making and resource management at both dispatch and on-scene. The present study was designed to examine the efficacy of a criteria based dispatch protocol and National Early Warning Score (NEWS) in the Finnish EMS system. In addition, the aim of the research was to obtain data on patient allocation and mortality in the Northern Finnish population. The study data included 13,354 EMS missions from a six-month cohort (1.1.2014 - 30.6.2014) of prehospital emergency patients in two hospital districts – Kainuu and Länsi-Pohja – in Northern Finland, using a retrospective, observational design. Prehospital data including patient clinical physiological variables were combined with the national Finnish registries (Care Registry for Health Care, Intensive Care Consortium Database and Cause of Death Registry) in order to examine risk assessment in EMS and prehospital patient outcomes. Based on the result, the risk assessment at the dispatch was correct in 67.5% of the cases and four out of ten EMS missions did not lead to transportation by an ambulance. The use of the Finnish dispatch protocol resulted in an overall rate of 23% of over-triage and a 9% rate of under-triage. The highest NEWS category showed a good sensitivity for 1-day mortality but failed to adequately discriminate patients in need of intensive care or who died within 30-days in a large, unselected, typical EMS population. In conclusion, the criteria based dispatch protocol resulted in over-triage of a quarter of missions and in a significant rate of EMS missions without ambulance transportation. In addition, the predictive value of prehospital NEWS regarding the patient´s risk of death and need for intensive care was low. / Tiivistelmä Ensihoitopalvelu on suunniteltu tarjoamaan nopeaa vastetta, paikalla tapahtuvaa hoitoa ja kuljetusta lopulliseen hoitopaikkaan potilaille, joilla on akuutti sairaus tai vamma. Viime vuosien lisääntyneet yhteydenotot ei-kiireellisissä asioissa on johtanut riskinarviotyökalujen kehittämiseen tukemaan päätöksentekoa ja resurssienhallintaa hätäpuhelun aikana ja tapahtumapaikalla. Tässä tutkimuksessa tarkasteltiin kriteeripohjaista hätäpuhelun käsittelyä sekä varhaisen varoituspistejärjestelmän (NEWS) tehokkuutta suomalaisessa ensihoitojärjestelmässä. Lisäksi tutkimuksen tavoitteena oli saada tietoa ensihoitopotilaiden hoitotuloksista ja kuolleisuudesta Pohjois-Suomessa. Tutkimukseen sisältyi 13 354 ensihoitotehtävää kuuden kuukauden kohortista (1.1.2014 – 30.6.2014) kahden sairaanhoitopiirin alueelta – Kainuu ja Länsi-Pohja – Pohjois-Suomessa käyttämällä retrospektiivistä havainnoivaa tutkimusmenetelmää. Ensihoidon aikana kerätty tieto, mukaan lukien potilaan kliiniset fysiologiset arvot, yhdistettiin kansallisiin rekistereihin (hoitoilmoitusrekisteri, tehohoitokonsortion laatutietokanta sekä kuolinsyyrekisteri) jotta ensihoitopotilaiden riskinarviota ja hoitotuloksia voitiin tutkia. Tutkimustulosten mukaan 67.5 prosentissa tapauksista riskinarvio hätäkeskuksessa oli oikea ja neljä kymmenestä ensihoitotehtävästä ei johtanut kuljetukseen ambulanssilla. Suomalaisen hälytysprotokollan käyttö johti yliarviointiin 23 prosentissa tapauksista ja aliarviointiin 9 prosentissa tapauksista. Korkeariskin NEWS-luokan herkkyys 1-päivän kuolleisuudelle oli hyvä, mutta se ei kyennyt erottelemaan riittävän hyvin potilaita, jotka tarvitsivat tehohoitoa tai kuolivat 30 päivän sisällä suuressa ei-valikoidussa tyypillisessä ensihoitopotilasväestössä. Yhteenvetona todettiin, että kriteeripohjaisen riskinarvion käyttö johti yliarvioon neljänneksestä tapauksista sekä huomattavaan ensihoitotehtävämäärään ilman ambulanssikuljetusta. Lisäksi ensihoidon aikana käytetyn varhaisen varoituspistejärjestelmän ennusteellinen arvo potilaan kuolemanriskin ja tehohoidon tarpeeseen oli matala.

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