Prehospital NEWS2

Introduction

NEWS2 is an early warning score system that is used to identify and respond to patients at risk of deteriorating. It is based on a simple scoring system in which a score is allocated to physiological measurements already undertaken when patients present to, or are being monitored in healthcare settings. The NEWS2 score with included parameters used to calculate the NEWS2 score can be shared from the external ambulance system to COSMIC. A NEWS2 profile is used to carry the score and also acts as the container of all vital parameters used to calculate the score. These parameters are referenced from the NEWS2 profile. The creation of a NEWS2 score can be solved in two ways:

• Use of a bundle which includes observation resources where both the NEWS2 score and the vital parameters are included. The NEWS2 observation should then include references to the vital sign observations.
• Use of the NEWS2 observation resource which holds the vital sign observations as contained resources.

The NEWS2 score is always calculated by a set of vital parameters. These must always be referenced from the profile.

The following six simple physiological parameters are included in the scoring system:

• Respiratory rate
• Oxygen saturations
• Temperature
• Systolic blood pressure
• Pulse rate
• Level of consciousness(ACVPU)

To create a NEWS2 in COSMIC the resource Observation is used. The NEWS2 observation can hold the NEWS2 total score but it is not mandatory. The NEWS2 observation must however reference all the related vital sign observations used to calculate the NEWS2 in the external system. The NEWS2 observation can be seen as a container of the included vital parameters.

Included Profiles

• ObservationNews2Lite - communicates News2 score of the patient based on the vital parameters referenced in the profile.
• ObservationAcvpuLite - communicates an ACVPU observation of a patient with any of the values Alert, Confusion, Voice, Pain or Unresponsive.
• ObservationOxygenSaturationLite Communicates the oxygen saturation of a patient in percentage and also if the patient has a hypercapnic respiratory failure (extension). The profile references the ObservationInspiredOxygenLite profile as an contained resource.
• ObservationBodyTemperatureLite - communicates a patient's body temperature in °C.
• ObservationBPLite - communicates a patient's systolic and diastolic blood pressure.
• ObservationHeartRateLite - communicates a patient's heart rate in beats per minute.
• ObservationRespiratoryRateLite - communicates respiratory rate of a patient in breaths per minute.

Bundle:

If a bundle is used to send the NEWS2 and vital paremeters the following bundle profile is used:

• BundleNews2 - The BundleNews2 profile may be used as a container for sending a NEWS2 and the vital signs used to calculate the NEWS2 to COSMIC. The bundle should contain all vital sign profiles used for calculationg a NEWS2 as well as the observationNews2Lite profile.

Use Cases

• Search for NEWS2 observations by patient using ObservationNews2Lite
• Create NEWS2 observations for a patient using ObservationNews2Lite
• Invalidate NEWS2 observations using ObservationNews2Lite

Demarcations

• NEWS2 subscores for each vital sign is not included in the API.