OBJECTIVES: To evaluate the safety and feasibility of an acute hospital at home model of care using the national early warning score (NEWS) as an early predictor of need for hospital transfer METHODS: Suitable patients in the ED requiring admission were offered a choice of hospital at home versus inpatient treatment. Patients were transferred home from the ED or acute ward under the hospital at home team. NEWS is recorded at admission and daily thereafter on a tablet by the nurse attending the patient at home. All patients’ record and NEWS data are available electronically to the doctors at the base hospital, who are available 24h/day to review deteriorating patients. We reviewed NEWS data from 502 patients cared for in an acute hospital at home. RESULTS: Of the 502 patients, 444 were discharged from home; 58 (11.5%) required transfer to hospital. Mean NEWS at admission of those who were discharged from home was 1.77± 1.90 versus 1.02±1.34 on discharge; mean NEWS for the transfer group was 2.22 ± 2.17 at admission and 3.10 ± 2.79 on transfer. We compared day to day change in NEWS (ΔNEWS) of transfer group to that of the discharge group. At 95 % confidence level there is no significant difference in the ΔNEWS between both group. However, at 90 % confidence level, analysis showed a small but significant difference, 90% CI (0.798 – 0.046), in the change in news from day 3 to 4 between the two groups. Mean Δ3-4 NEWS for the transfer group was + 0.35; Mean Δ3-4 NEWS for the discharge group was – 0.07. CONCLUSIONS: The results indicate that NEWS correlates well with clinical deterioration at home. As well as being an efficient track and trigger mechanism, NEWS in the first 4 days of admission may be used to predict which patients will require transfer.