New NHS system to help doctors spot deteriorating children faster in emergency departments

The NHS is rolling out an innovative early warning system for doctors and nurses in emergency departments (ED), to help spot and treat deteriorating child patients, faster.

The National Paediatric Early Warning System (PEWS) will be introduced in emergency departments from this winter, giving staff a clear, consistent way to track signs that a child's condition is deteriorating, and ensure they get the attention they need, without delay.

The system sees staff measure, record and assess vital signs, such as blood pressure, heart rate, breathing rates and oxygen levels.

An overall score is then given, with higher scores meaning a child will be given more urgent attention. The mass roll-out in England will make PEWS the largest standardised scoring system for children's health in the world. 

Parents and carers will also be asked about concerns around changes in a child's condition, as part of the system. Concerns identified through either staff's judgement or raised by parents, carers or the child themselves, will trigger an immediate escalation of care even if their clinical score is low.

More than 90 hospitals across England are already using the national PEWS system in paediatric inpatient wards. Data shows these trusts have consistently lower rates of cardiac arrests among their patients.

The rollout forms part of a range of measures outlined by the NHS to get winter ready, such as opening flu vaccination bookings earlier than ever.

All NHS trusts completed their plans for winter by the end of August, with plans stress tested by end of September.

It also comes just a month after the NHS announced it was expanding Martha's Rule to all hospital A&E departments and waiting rooms to further boost patient safety for some of the most vulnerable patients. The initiative will see patients, loved ones and staff in busy emergency departments able to call a dedicated Martha's Rule phone number to trigger an urgent review if a patient's condition is deteriorating and they are concerned this is not being listened to.

NHS England is also drawing up urgent new standards for how children should be treated in A&E, including an urgent plan to eliminate corridor care for children as a priority.

Duncan Burton, Chief Nursing Officer for England, said: Introducing this system into Emergency Departments is an important next step in improving care for children and young people across England for this winter - and beyond.

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.

Over 6 million children attend EDs in England each year, with most having mild or self-limiting illness, according to NHS data.

Health chiefs see the mass rollout of PEWS into EDs as the next step in the NHS's ongoing work around better identifying children with serious diseases or health issues early.

The national PEWS programme development was led by NHS England in collaboration with the Royal College of Paediatrics and Child Health and the Royal College of Nursing, with input from clinical teams. 

A similar process for adults, the National Early Warning System is already in use by NHS hospitals. 

Unlike adults, the system for children has separate age-appropriate charts, which reflect the different normal ranges and clinical needs of babies, children and young people, while the emergency department design supports support rapid decision making across the breadth of acute presentations seen in a busy care environment.

Health and Social Care Secretary Yvette Cooper said: "I've been clear that children's health needs to be a much greater focus for the whole NHS. All of us want the reassurance of knowing that if a child is seriously ill, it will be spotted in time by the NHS and that's exactly what this new early warning system, developed by expert clinicians, is designed to do. So if a child is getting worse or when a parent says something isn't right, they will be listened to, their concerns will be acted on and lives will be saved.

This is just one measure we're taking to make children's health a priority. I have also asked the NHS to draw up new standards for how children are treated in A&E and draw up plans to urgently put an end to corridor care for children."

All hospitals with a paediatric inpatient setting are transitioning to the NPEWS with rapid uptake since its launch in November 2023. While standardised scoring systems have been used in some States in Australia, and notably country-wide in Denmark, the scale of the roll-out in England would make it the largest standardised scoring system in the world. 

RCN Chief Nursing Officer, Professor Lynn Woolsey, 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.

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. Alongside training and resources, it will help teams across England improve equity, patient safety, and quality of care by providing standardised ED appropriate resources.

The NHS will be rolling out supporting resources to help emergency department teams prepare for and embed the system, including guidance and education for staff.

Royal College of Paediatrics and Child Health, Vice-president for Policy, Dr Mike McKean, 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 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. Alongside training and resources, it will help teams across England improve equity, patient safety, and quality of care by providing standardised ED appropriate resources.

Further information about the National Paediatric Early Warning System is available via NHS England's website.