Lives can be extended and harm avoided if ‘at-risk’ patients are identified as early as possible. UCLH teams developed screening and prediction tools which have been incorporated into national guidelines, improving outcomes for thousands of patients. These include the National Early Warning Score (NEWS/NEWS2), recommended for screening the 16,000,000 NHS patients annually admitted to hospital; the Intensive care Psychological Assessment Tool (IPAT) for screening the 250,000 NHS patients admitted to critical care per year; and the Surgical Outcome Risk Tool (SORT) for assessing the 3,000,000 people each year who have surgery requiring an NHS hospital stay.
NEWS was developed in 2012 and updated in 2017 (NEWS2) by a taskforce chaired by UCLH Professor Bryan Williams, also including UCLH nurse consultant John Welch. It identifies patients at risk of poor outcomes using a score derived at the bedside from routine measurements (e.g. heart rate). NEWS2 is recommended by NHS England for use across healthcare, including care homes, ambulances and hospitals. Since implementation, there has been a significant fall in hospital cardiac arrests1 and fewer deaths from suspected sepsis in primary care.
In 2009 NICE recommended psychological screening for all critically ill patients, as one third suffer psychological harm linked with negative long-term consequences. In response, IPAT was developed by UCLH clinicians including psychologist Dr Dorothy Wade and physicians Professor Monty Mythen and Dr David Howell. Beyond its use in clinical trials, IPAT remains the only tool recommended for psychological screening in national intensive care guidelines2.
Each year >50,000 patients die within 30 days of major surgery and 500,000 suffer potentially life-changing complications. To improve this situation the NCEPOD health watchdog approached UCLH Professor Ramani Moonesinghe and the BRCsupported Surgical Outcomes Research Centre (SOuRCe) to develop a UK-wide preoperative risk prediction system (2011).
The result, SORT (sortsurgery.com / via an app), accurately predicts 30-day mortality risk and is recommended in national guidelines for pre-operative assessment. SOuRCe-led research in over 90% of NHS hospitals led to a recent update to include clinician judgement3. New multi-centre research led by SOuRCe found that SORT successfully identifies those who would benefit from planned critical care after surgery, supporting best use of NHS resources and improved patient outcomes.
1. Hogan H et al. BMC Health Services Res, 2020; 2. Faculty of Intensive Care Medicine, Guidelines For Provision Of Intensive Care 2019; 3. Wong DJN et al. PLOS Med, 2020
