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Study: Use of clinical deterioration tool in care homes could reduce hospital admissions

Study: Use of clinical deterioration tool in care homes could reduce hospital admissions
By Awil Mohamoud
13 October 2020

A tool that allows care homes to measure and share residents’ vital signs with health services could help to avoid unnecessary hospital admissions, a study has found.

Researchers analysed the use of the National Early Warning Score (NEWS) – introduced in care homes in a north England CCG area in 2018 – to identify challenges around its implementation.

The study, which involved interviews with 21 health and care staff, concluded that having a NEWS measurement to hand ‘often enabled staff to communicate more effectively with external healthcare services, with a view to avoiding unnecessary hospital admissions’.

Care home staff and other professionals involved in the study said the tool could also ‘enhance the response to acute illness’ and ‘increase the confidence of care home staff’.

Training for care staff

The system enabled staff in 47 care homes to record residents’ vitals, such as their respiratory rate, oxygen saturation and temperature, on a tablet computer that gives an aggregate NEWS score along with associated responses, such as when to seek medical help.

The CCG delivered technical support and training to a selection of care home staff on how to take vital signs and input the data, which they were required to do for each resident on a monthly basis, and when a resident was feeling unwell.

The data was also designed to be shared with health professionals, such as GPs, community nurses, NHS 111, and urgent care services, to inform triage and decision making.

Inconsistencies across care homes

The study highlighted the key role care home staff play in identifying changes in residents’ health, but said many had limited or no healthcare experience.

It found issues around engagement, with CCG data indicating that only a third of care homes regularly used the scoring tool. Some care homes also experienced problems in measuring the vital signs, as the results showed inaccurate and absent readings.   

The report said: ‘Health professionals believed that some care homes were struggling with basic elements of care, such as hydration, making the introduction of NEWS potentially inappropriate.’

The training provided was also undermined by the fact that multiple care homes experienced a high staff turnover and regular changes in management, leading to inconsistency in training and skills across care homes, the research found.

‘Ongoing monitoring needed’

The report said: ‘Care home work was viewed as undervalued, because of its demanding nature and low pay. Asking care home staff to do more complex work like the NEWS was, at times, framed as problematic, and likely to compromise the time carers had with individual residents.’

The researchers concluded that these inconsistencies meant the key purpose of introducing the tool in care homes ‘appeared to have been lost’.

They added that the evaluation had highlighted the need to involve care home staff and primary care services when developing and implementing interventions in care homes, and that the appropriateness and value of NEWS in non-acute settings required ongoing monitoring.

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