Clinical response thresholds (acuity) in acutely unwell patients: onset-outcome

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. 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 & includes a diverse ethnic & socio-economic mix. There is a higher than average percentage of minority ethnic groups. WM has a large number of elderly residents but is the youngest population in the UK. Birmingham has the highest birth rate in England. It also has the highest infant mortality rate. WM life expectancy is 1.8 years less than in London. There are particularly high rates of physical inactivity, obesity, smoking & diabetes. Each day >100, 000 people are treated in hospital, see their GP or are cared for by the NHS.

EHR. University Hospitals Birmingham NHS Foundation Trust (UHB) is one of the largest NHS Trusts in England, providing direct acute services & specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds & 100 ITU beds. UHB runs a fully electronic healthcare record (EHR) (PICS Birmingham Systems), a shared primary & secondary care record (Your Care Connected) & a patient portal “My Health”.

Scope: All hospitalised patients to UHB from 2000 – current day. Updated monthly. Longitudinal & individually linked, so that the preceding & subsequent health journey can be mapped & healthcare utilisation prior to & after acute admission interrogated. The dataset includes all admission ICD-10 & SNOMED-CT codes including medical, surgical, paediatrics. Serial, structured data pertaining to process of care (timings, staff grades, specialty review, wards), presenting complaint, all physiology readings (pulse, blood pressure, respiratory rate, oxygen saturations), all blood results, microbiology, all prescribed & administered treatments (fluids, antibiotics, inotropes, vasopressors, organ support), all outcomes. Linked images available (radiographs, CT, MRI, ultrasound). Includes but not limited to COVID-19 wave 1 and wave 2 data.

Available supplementary data: Matched ‘elective’ controls ambulance, 111, 999 data, synthetic data.

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