Centre for Healthcare Modelling and Informatics

Impact of our clinical outcomes research

2014 REF impact case study

Our work has had considerable impact (and formed a highly-rated case study for the 2014 REF), including:

  • Practitioner/professional service impact. Our work on clinical outcome modelling has influenced the Royal College of Physicians' (RCP) new standard for the assessment of the severity of acute illness (known as the "National Early Warning Score" or NEWS). The specific recommendation is for adoption by NHS bodies, but is already being adopted internationally.
  • Health impact. The chairman of the RCP working party estimated that our work could result in the saving of thousands of lives per year.
  • Economic impact. Our work is incorporated in the VitalPAC system developed by The Learning Clinic Ltd (TLC), and (as of 2013) was deployed to more than 20 hospitals.

Economic impact on TLC

TLC have incorporated our ViEWS (VitalPAC Early Warning Score) model (and more recently, NEWS, see below) into their VitalPAC family of products. This work was done as part of a KTP (April 2006 - April 2008) to give them that capability. The KTP associate was also involved in the development of the doctor interface to the system. TLC became aware of us because of our BHOM work and our links with the Vascular Society of GB & Ireland.

VitalPAC replaces the typical paper chart at the foot of a hospital patient's bed by recording (electronically on a mobile device) the vital signs measurements, typically taken by a nurse every few hours. ViEWS/NEWS translates the vital sign measurements into a single number known as an early warning score (EWS). Depending on the value, the nurse is instructed to take some action, which (in increasing order of severity) involves taking further observations more frequently, calling a doctor to see the patient, or calling a doctor urgently. Our research identified recommended thresholds for these actions. The economic benefits to TLC included increased turnover (13-fold over 3 years), created 15 new jobs, and allowed them to attract over £1m from private investors. As of 2013, the VitalPAC product generated 80% of their revenue.

Policy impact on RCP work

In 2012, the Royal College of Physicians (RCP) published a report recommending adoption across the NHS of a new National Early Warning Score (NEWS) for monitoring patients in hospital (see press release). NEWS is (with only a couple of small changes) based on ViEWS as published in our 2010 paper. The background to this was that the RCP had set up a NEWS Development and Implementation Group (NEWSDIG). One of the members of the group was Professor Gary Smith, our long-time collaborator and a former Consultant Physician at PHT, now affiliated to Bournemouth University. David Prytherch and Gary Smith undertook (on behalf of NEWSDIG) the performance analysis that confirmed the weightings, triggers and escalation criteria.

Health impact and the ultimate beneficiaries

Ultimately the research impacts everyone who is admitted to a hospital that uses the system. Portsmouth Hospitals Trust led the way – it served as the development site for the VitalPAC software. PHT began piloting the software in 2006 and by 2010 its use had spread to the whole hospital. As of 2013, ViEWS/NEWS was used in 20 hospitals via the VitalPAC system, but it has also been carefully designed to be used in hospitals still using paper records. A survey of 116 UK hospitals by the National Outreach Forum revealed that (as of September 2013) 28% had already implemented NEWS, a further 31% planned to introduce it within a year and a further 9% had longer-term plans. Only 8% were not considering it. NEWS has 100% adoption by NHS Wales and it has been adopted by the Health Service Executive in the Republic of Ireland.

Since introducing VitalPAC, there is evidence from two hospitals that it reduces mortality.

A 2012 study published in the journal BMJ Quality and Safety found there were nearly 12,000 avoidable deaths of adults in English acute hospitals annually. In the publicity surrounding the RCP's publication of NEWS, the chairman of the Working Party (Professor Bryan Williams from UCL) estimated that up to half of those lives might be saved. Not only does NEWS aid in identifying deteriorating patients in need of additional clinical intervention, but its adoption nationally results in savings in the training of nurses. This attracted much press attention, for example by the BBC and the Independent.

Finally, the collaboration between PHT and TLC for the development of the VitalPAC system has won three national awards (the NHS Connecting for Health Leadership in Health Information Accolades Scheme 2006, the "Technology and IT to improve Patient Safety" category in the 2010 Health Service Journal/Nursing Times Patient Safety Awards, and the Bupa Foundation Patient Safety Award 2010).

REF version of this