What is the NEWS2 Score?
NEWS2 is a standardized and evidence-based system used by healthcare professionals to monitor and assess acutely ill adult patients. It assigns a score from 0 to 3 for any deviation from a normal physiological range for six key parameters, and adds a score for supplemental oxygen use, with a total aggregate score ranging from 0 to 20. The total score determines the patient's risk level and the urgency of the required clinical response. The system creates a 'common language' of acuity, enabling consistent communication and action across different care settings, including hospitals, ambulances, and community care.
The Physiological Parameters of NEWS2
The NEWS2 score is based on measuring the following seven physiological parameters. Each parameter has a specific scoring scale, where higher scores are assigned to measurements that deviate significantly from the normal range:
- Respiratory Rate: The number of breaths per minute. A rate that is very low or high indicates significant distress.
- Oxygen Saturation (SpO2): The percentage of oxygen in the patient's blood. NEWS2 uses two different scales for this parameter.
- Scale 1: The standard scale for most patients, targeting a saturation of 94–98%.
- Scale 2: A dedicated scale for patients with confirmed hypercapnic respiratory failure (such as those with COPD), for whom a lower target of 88–92% is appropriate.
- Supplemental Oxygen: An additional two points are added if the patient requires supplemental oxygen to maintain their oxygen saturation.
- Systolic Blood Pressure: The top number in a blood pressure reading. A very high or very low pressure triggers a higher score.
- Heart Rate: The pulse rate, measured in beats per minute.
- Level of Consciousness (using AVPU): This assesses the patient's neurological state. It has been modified from AVPU (Alert, Voice, Pain, Unresponsive) to ACVPU for NEWS2 to include a specific score for 'new confusion'.
- Temperature: Body temperature, measured in degrees Celsius.
Interpreting the Aggregate NEWS2 Score and Response Levels
Once the scores for each parameter are tallied, the aggregate NEWS2 score falls into one of three risk categories, each with a defined monitoring frequency and clinical response protocol. However, it's crucial to remember that a single, highly deviated parameter (scoring 3) also requires urgent clinical review, regardless of the total score.
NEWS2 Risk Levels and Corresponding Actions
| NEWS2 Aggregate Score | Risk Level | Monitoring Frequency | Clinical Response Triggered |
|---|---|---|---|
| 0 | Low Risk | At least every 12 hours. | Routine NEWS monitoring continues. No immediate escalation needed. |
| 1-4 | Low Risk | At least every 4 to 6 hours. | A registered nurse must assess the patient. Increased monitoring or escalation may be required. |
| Single Score of 3 | Medium Risk | At least every 1 hour. | Requires urgent review by the medical team to decide on escalation, even if the total score is low. |
| 5-6 | Medium Risk | At least every 1 hour. | Urgent assessment by a clinician or team with expertise in acutely ill patients, within 60 minutes. |
| 7 or higher | High Risk | Continuous monitoring of vital signs. | Emergency assessment by a team with critical care competencies (e.g., intensive care team) within 30 minutes, considering transfer to a higher dependency unit. |
Why Context is Critical to NEWS2 Interpretation
While the NEWS2 score provides a standardized metric for patient acuity, it is not a standalone tool. Proper interpretation must be combined with overall clinical judgment and a patient's individual history. Healthcare professionals are trained to consider other factors that might not be captured by the score alone, such as the patient's baseline health, comorbidities, frailty, and the presenting illness. For example, a patient with end-stage heart failure may have a persistently raised NEWS2 score, in which case the clinical response must be tailored to their care plan, rather than triggering automatic escalations. Conversely, a young patient might have a low NEWS2 score while experiencing serious underlying issues that require closer monitoring, as they can compensate for deterioration for longer. It is also important to consider the trends over time; a stable score is interpreted differently than a rapidly rising one.
Beyond Hospital Walls: NEWS2 in Community Care
The use of NEWS2 has expanded beyond acute hospital settings to improve communication and care coordination in other environments, including ambulance services, general practice, and care homes. This creates a consistent language for patient acuity, allowing seamless handover of information between healthcare professionals. For example, paramedics can communicate a patient's NEWS2 score to an emergency department to expedite the patient's evaluation. In care homes, tools like RESTORE2 combine NEWS2 with other assessments to help staff identify and communicate signs of deterioration more effectively. This system-wide approach helps ensure that patients, wherever they are, receive a timely and appropriate response to changes in their condition.
Conclusion: Interpreting the Score for Better Care
Learning how do you interpret NEWS2 scores reveals a simple yet powerful system designed to standardize patient monitoring and improve safety. By aggregating scores for key vital signs, NEWS2 provides a clear, objective measure of a patient's illness severity and risk of deterioration. However, its true value is realized when interpreted alongside sound clinical judgment, the patient's medical history, and any specific care plans. This holistic approach ensures that the right level of care is triggered at the right time, leading to more timely and effective interventions and ultimately improving patient outcomes.
