The world’s largest “early warning system” to spot when sick children are dangerously deteriorating is being introduced in A&E departments across England, NHS leaders have said.
The national paediatric early warning system (Pews) uses a scoring system for vital signs to assess whether a child needs more urgent attention. It is already used for inpatients, but NHS England has said this winter will be the first time it is used in A&E.
The mass rollout in England will make Pews the largest standardised scoring system in the world. Doctors and nurses can use it to measure, record and assess vital signs, such as blood pressure, heart rate, breathing rates, oxygen levels and consciousness.
A high score helps flag to medical staff when a child is deteriorating, though it was not designed to replace professional judgment or the input of parents, carers and children into a child’s condition, NHS England said.
Concerns raised can still trigger an immediate escalation of care, even if a child’s Pews score is low.
Duncan Burton, the chief nursing officer for England, said: “In fast-paced emergency departments, staff need to spot quickly when a child’s condition is deteriorating.
“This standardised approach will help them recognise the warning signs, communicate concerns, and make timely decisions when every moment matters.
“Just as importantly, it makes sure the concerns of children, parents and carers are heard and can prompt action.”
The Pews includes age-appropriate charts to reflect what may be abnormal signs of deterioration in babies, children and young people.
The scheme has also been designed specifically for A&E to help with rapid decision-making in busy environments.
More than 6 million children attend A&E in England each year. A similar process for adults, the national early warning system, is already used by NHS hospitals.
Separately, NHS England is drawing up urgent new standards for how children should be treated in A&E, including eliminating corridor care for youngsters as a priority.
Dr Mike McKean, the vice-president for policy at the Royal College of Paediatrics and Child Health (RCPCH), which worked on the new Pews system, said: “I am delighted to see this initiative being rolled out ahead of the winter period, which is always a busy and challenging time for hospitals and healthcare professionals.
“The emergency department Pews charts are extremely important tools that will support all paediatricians and wider child health teams to spot deterioration in children in hospital.
“Alongside training and resources, it will help teams across England improve equity, patient safety and quality of care.”
Prof Lynn Woolsey, of the Royal College of Nursing, which was also involved in the work, said: “Early escalation is critical for keeping patients safe, particularly children.
“Already saving lives in other parts of the NHS, this system is a vital tool for nursing staff to quickly identify when a child patient is deteriorating, and act.
“The emphasis on listening to children, young people, parents and carers is especially important and having a standardised approach across emergency departments and paediatric wards will help support consistent assessment, communication and decision-making.
“It will be crucial to ensure there are enough nursing staff, with enough capacity, and the necessary training and support, to spot deterioration and use the system effectively.”
More than 90 hospitals across England use the national inpatient Pews system and data suggests they have consistently lower rates of cardiac arrests among their patients, according to NHS England.
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