THE NHS is rolling out a new initiative to all emergency departments in England that will allow parents of sick children to immediately trigger an escalation in their care if they become worried their condition is deteriorating.
Known as the National Paediatric Early Warning System (PEWS), it is to be the largest of its kind globally and will implement a scoring system based on vital signs like blood pressure, oxygen levels and heart rate for staff to assess whether a child needs more urgent attention.
The rollout of the A&E scheme builds on the previous introduction of national PEWS charts to children’s inpatient wards across England in November 2023.
Extending the approach to emergency departments aims to help staff identify children who become more unwell while awaiting or receiving treatment in a first-line, often busier setting.
Data from the 90 hospitals in England that already implement the PEWS system suggests they have consistently lower rates of cardiac arrests among their patients, according to NHS England.
When triggered by staff, parents, carers or the child themselves, staff will record observations and use the charts to determine when further assessment or intervention is needed.
The emergency department system links initial triage with ongoing monitoring, supporting a consistent approach as children move through hospital care.
While a high overall score will flag to medical staff that a child’s condition is deteriorating, concerns raised can still trigger an immediate escalation of care even if the PEWS score remains low.
Introduced with the aim to save the lives of children as the winter approaches – the busiest time of year for the NHS and when pressure on staff is at its highest – a similar scheme already exists for adults which has proven to be largely successful.
It also follows a commitment by the UK government to end corridor care in A&Es for children because of long waits for hospital beds.
Developed by NHS England alongside the Royal College of Paediatrics and Child Health (RCPCH) and the Royal College of Nursing, PEWS aims to standardise the system for assessing children and reduce variation between hospitals.
Dr Mike McKean, Vice-President for Policy at the RCPCH said about the announcement: “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 launch of 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.
He added: “Alongside training and resources, it will help teams across England improve equity, patient safety, and quality of care by providing standardised ED appropriate resources.”
Professor Damian Roland, Consultant in Paediatric Emergency Medicine, agreed, laying out the next steps for the scheme: “The delivery of ED NPEWS links triage to ongoing observations in Children’s Emergency Departments as well as standardising escalation across the country.
“It’s link to the inpatient chart is the next stage in delivering a truly cross system approach to the recognition of sick children.”
The roll out of the PEWS scheme follows the announcement that Martha’s Rule, a patient safety initiative that provides patients, relatives, and NHS staff another route to raise concerns about deteriorating health, will also be expanded to every accident and emergency department in England
Inspired by a teenage girl who died after receiving inadequate care, similarly it will allow people to contact a dedicated hospital helpline when they believe a patient’s condition is worsening and their concerns are not being addressed. A separate clinical team can then conduct an urgent review and recommend changes to the patient’s care.
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