Electronic NEWS for sepsis screening reduces triage-to-intervention time
Sepsis is a life-threatening medical emergency that can affect anyone. It occurs when the body overreacts to an infection. An early recognition of sepsis is crucial to initiating treatment in a timely manner and can save lives.
Every fifth person dies of sepsis
Despite treatments that are available, sepsis is a serious condition with high mortality. In their 2020 report, the WHO estimates that sepsis causes roughly 20% of annual global deaths. In other words, every fifth person dies of sepsis! Sepsis is particularly common in the elderly and infants, as well as in patients with severe illnesses or medications that suppress the body’s defense mechanisms.
On the other hand, it is reported worldwide that deaths caused by sepsis are declining, although cases of sepsis are on the rise. The relative reduction in mortality can be explained by improved sepsis screening and quicker interventions. The increase in cases, in turn, is likely due to the aging population with more predisposing comorbidities.
The new SSC guidelines recommend SIRS, NEWS, or MEWS for sepsis screening
The Surviving Sepsis Campaign’s (SSC) guidelines highlight routine screening of high-risk patients to improve the early recognition and treatment of sepsis. The SSC guidelines, updated in 2021, recommend SIRS, NEWS, or MEWS as a single-screening tool for sepsis or septic shock.
The NEWS (National Early Warning Score) and the MEWS (any custom-Modified EWS scale) are based on the principle that clinical deterioration can be detected through changes in vital signs. The measured values (six physiological parameters) are scored according to how much they deviate from the normal range. The total score indicates the patient’s risk class (low, medium or high), for which the hospital determines corresponding clinical measures, such as alerting the medical team. A NEWS score of 5 or more indicates that the patient has high risk of sepsis – or the patient may even have it already3.
The adoption of electronic NEWS helps to reduce in-hospital mortality
Initially, the NEWS has been paper-based. Due to their much better usability, many hospitals have adopted electronic and mobile tools for NEWS processes. Studies have shown that the electronically collected and calculated NEWS is more reliable and accurate than the paper-based method.4
The main advantage of the electronic NEWS is that it doesn’t cause any additional burden to healthcare professionals – neither during collection nor calculation. The patient data needed for the calculation is collected as part of the routine care process, and when documented at the point of care, it is accessible in real time as well. What is more, the score calculation is automated.
According to a study5 published in 2018, and a few others supporting the results, the median triage-to-intervention time was reduced from 12 hours and 24 minutes to 27 minutes after the adoption of electronic warning system for clinical signs of infection, compared to manual surveillance. The sepsis-related in-hospital mortality decreased by nearly 38%.
References:
1. World Health Organization (2020): Global report of the epidemiology and burden of sepsis: Current evidence, identifying gaps and future directions.
2. Evans et al. (2021): Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock. Critical Care Medicine.
3. NHS England (2017): Sepsis guidance implementation advice for adults.
4. Mohammed et al. (2009): Improving accuracy and efficiency of early warning scores in acute care. Br J Nurs.
5. Westphal et al. (2018): An electronic warning system helps reduce the time to diagnosis of sepsis. Revista Brasileira de terapia intensiva
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