Improving Compliance with the National Early Warning Score 2 (NEWS2) in an Egyptian Central Hospital Emergency Department: A Two-Cycle Clinical Audit

Abstract

Background: NEWS2 is a standardized assessment tool used to determine illness severity and identify patients at risk of deterioration. However, its effectiveness is limited by systemic barriers. This audit primarily aims to evaluate NEWS2 compliance in an emergency department and implement targeted interventions to address recognized gaps.

Methods: A two-cycle clinical audit was conducted at ShubraKhit Central Hospital's ED over a period of three weeks. Cycle 1 (August 18–25, 2025) established a baseline by assessing vital sign documentation, NEWS2 calculation, and escalation practices in 50 patients. The analysis of the root causes successfully identified the key barriers. Targeted interventions were implemented. Cycle 2 (September 1–8, 2025) re-audited the other 50 patients to evaluate the impact of the intervention. Data were analyzed using chi-square or Fisher’s exact tests as appropriate, with effect sizes and 95% CIs.

Results: Cycle 1 showed serious and critical drawbacks, with only 2% of patients having a complete set of vital signs documented, and NEWS2 calculated in only 2% of cases. The primary barriers were a lack of equipment (96%) and a 100% lack of awareness of the escalation protocol. Following the suitable intervention, Cycle 2 demonstrated a significant improvement, with 100% of patients having all vital signs documented, and NEWS2 calculated in 96% of cases.

Conclusions: A targeted intervention focuses on addressing specific root causes, leading to compliance with the NEWS2 scoring system. This ensures that evidence-based quality improvement can bridge the gap between clinical guidelines and practice.