highest ranking, therefore the patient should be assessed immediately. The calculated score on the NEWS may determine a higher categorie score for assessment and the nurse may use
their clinical judgement and be able to justify the reason why they have escalated care for that patient. Alam et al. (2015) explore the value of the NEWS in a recent prospective, observational feasibility study, performed in an emergency department, focusing on just how the NEWS is used at first assessment, additionally examining its worth whilst in the emergency department in highlighting the deteriorating patient. This study has proven the reliability of the NEWS when recognising the deteriorating patient, clinicians were proficient in changing the category of the patient when deteriorating was evident, escalating the patient for a more immediate assessment within the emergency department. Although this study supports the use of the NEWS as a beneficial tool within the emergency department to detect the deteriorating adult patient, the writer draws attention to the fact; that due to the nature of the emergency department; the patient will, more often than not, be assessed, treated, discharged or admitted within a four hour target, therefore the clinical judgement of the nurse when monitoring the patient is of great value to optimise patient care. Cameron et al. (2013) have recently pioneered a new early warning scoring tool with the intent of forecasting, at first assessment in triage, whether the patient will require admission or be considered suitable to be assessed and discharged from the Ambulatory Care units. The Glasgow Admission Predictor (GAP) is calculated using a point scoring system using six variables (Appendix 4); the NEWS plays a role within this tool. Once the scores are calculated at triage, a score of less than twenty five would mean that the patient should be transferred to the Ambulatory Care unit for assessment, with the potential of being discharged home after the completion of assessment. A score of above twenty five would
mean that the probability of an admission to hospital for the patient, therefore the patient would be allocated a room in the mainstream ward to be assessed. Through experience, utilising this tool into practice the writer has found this to be extremely subjective, for example; a patient may present to the department complaining of slight chest discomfort, appearing sweaty and clammy however scoring less than twenty five on their GAP score, ultimately they would not be sent to the Ambulatory Care unit as the nurse would use their clinical judgement, and escalate the patient as a high priority for assessment. Limitations were met by the writer on this topic whilst attempting to critically analyse the GAP, as minimal information could be sourced within the databases, therefore no assurances could be provided as to the effects of this admissions predictor within the clinical area.