The national paediatric early warning system (Pews) will be introduced in A&E departments across England this winter, NHS England has said, in what NHS leaders describe as the world’s largest early warning system for severely ill children. The system is already used for inpatients, but this will be the first time it is deployed in emergency departments.
Pews uses a scoring system for vital signs to assess whether a child needs more urgent attention. Doctors and nurses can measure, record and assess signs including blood pressure, heart rate, breathing rates, oxygen levels and consciousness. A high score helps flag when a child is deteriorating, although NHS England said the tool was not designed to replace professional judgment or the input of parents, carers and children. Concerns raised can still trigger an immediate escalation of care even if a child’s Pews score is low.
The system includes age-appropriate charts to reflect what may be abnormal signs of deterioration in babies, children and young people, and has been designed specifically for A&E to support 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.
Duncan Burton, chief nursing officer for England, said staff in fast-paced emergency departments need to spot quickly when a child’s condition is deteriorating. He said the standardised approach would help them recognise warning signs, communicate concerns and make timely decisions, and would also ensure the concerns of children, parents and carers are heard and can prompt action.
Dr Mike McKean, vice-president for policy at the Royal College of Paediatrics and Child Health, which worked on the system, welcomed the rollout ahead of winter, describing the emergency department Pews charts as important tools to support paediatricians and wider child health teams in spotting deterioration. Prof Lynn Woolsey of the Royal College of Nursing, also involved in the work, said early escalation is critical for keeping patients safe, particularly children, and that the system is a vital tool for nursing staff. She added that having a standardised approach across emergency departments and paediatric wards would support consistent assessment, communication and decision-making, while ensuring enough nursing staff with the necessary training and support would be crucial.
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. More than 90 hospitals across England use the national inpatient Pews system, and NHS England said data suggests they have consistently lower rates of cardiac arrests among their patients.
Sources: The Guardian World.