The national early warning score during unscheduled home visits: retrospective cohort study

Background Home health care is an essential alternative to hospital care and its use is expanding. However, early recognition of clinical deterioration in the home setting is difficult, particularly in older adults with complex health conditions.

Aim We investigated whether the National Early Warning Score (NEWS), a tool based on vital signs, could predict short-term mortality following unscheduled home visits in patients receiving home health care.

Design & setting This retrospective cohort study focused on unscheduled home visits conducted in four centres in Japan from June 2023 to May 2024.

Method This study included 589 unscheduled home visits to 234 patients. Vital signs were recorded by visiting nurses during unscheduled visits, and the NEW scores were calculated later. The primary and secondary outcomes were 2-day and 7-day mortality, respectively. Generalised linear mixed models were used to predict the probability of death.

Results The median patient age was 80 years, and the median NEW score was 3. The 2-day mortality was 29/234 (12.4%), and the 7-day mortality was 44/234 (18.8%). The NEW score was a significant predictor of both 2-day mortality (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.42–2.52, P<0.001) and 7-day mortality (OR 2.14, 95% CI 1.59–2.89, P<0.001). The risk of death increased as the NEW score increased.

Conclusions The NEW score during unscheduled home visits is associated with significantly increased short-term mortality. By identifying patients at high risk of death, wider implementation of NEWS could support clinical decision-making and improve patient safety.