World's Largest Early Warning System for Deteriorating Children to Launch in A&Es across England

The world's largest ‘early warning system’ to spot when sick children are dangerously deteriorating is being introduced in accident and emergency (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 NHS England said it was not designed to replace professional judgment or the input of parents, carers and children into a child's condition. 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.’ He added that it makes sure the concerns of children, parents and carers are heard and can prompt action.

The system includes age-appropriate charts to reflect what may be abnormal signs of deterioration in babies, children and young people, and it has 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, and a similar process for adults, the national early warning system, is already used by NHS hospitals.

Dr Mike McKean, vice-president for policy at the Royal College of Paediatrics and Child Health (RCPCH), which worked on the new Pews system, said he was delighted to see the initiative rolled out ahead of the winter period, which is always a busy and challenging time for hospitals. He said the emergency department Pews charts are extremely important tools that will support paediatricians and wider child health teams to spot deterioration in children in hospital.

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, and that the system, already saving lives in other parts of the NHS, is a vital tool for nursing staff. She said it will be crucial to ensure there are enough nursing staff, with enough capacity, and the necessary training and support, to use the system effectively.

According to NHS England, 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. 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.