Background

Early warning systems (EWS) are bedside tools used to assess basic physiological parameters to identify patients with potential or established critical illness. Evidence suggests that they may predict risk of intensive care admission, death and length of hospital stay. In 2017, the Royal College of Physicians (RCP) published an updated National Early Warning Score, referred to as NEWS2, based upon six physiological parameters (heart rate, blood pressure, respiratory rate, peripheral oxygen saturations, temperature and level of consciousness). It is associated with specific clinical response recommendations in which a step change occurs at a threshold NEWS2 score >5, requiring an urgent clinical response no matter what the presenting complaint or condition.

PIONEER geography: The West Midlands (WM) has a population of 5.9 million and includes a diverse ethnic and socio-economic mix.

EHR. UHB is one of the largest NHS Trusts in England, providing direct acute services and specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds and an expanded 250 ITU bed capacity during COVID. UHB runs a fully electronic healthcare record (EHR) (PICS; Birmingham Systems), a shared primary and secondary care record (Your Care Connected) and a patient portal “My Health”.

Scope: Serial NEWS2 scores of acutely unwell patients recorded during their hospital stay with each individual component of NEWS2 reported. Longitudinal and individually linked, so that the preceding and subsequent health journey can be mapped and healthcare utilisation prior to and after admission understood. The dataset includes highly granular patient demographics, co-morbidities taken from ICD-10 and SNOMED-CT codes. Serial, structured data pertaining to process of care (timings, admissions), presenting complaint, physiology readings (e.g. heart rate, blood pressure, respiratory rate, NEWS2 score and oxygen saturations), Lab analysis results (Alanine Transferase, albumin, Hb, Creatine Kinase, White Blood Cells and others), microbiology results, medications and all outcomes.

Available supplementary data: Matched controls; ambulance, OMOP data, synthetic data.

Available supplementary support: Analytics, Model build, validation and refinement; A.I.; Data partner support for ETL (extract, transform and load) process, Clinical expertise, Patient and end-user access, Purchaser access, Regulatory requirements, Data-driven trials, “fast screen” services.