A&E warning system to flag dangerously ill children

Hospitals across England are set to introduce a new early warning system aimed at helping emergency department staff quickly identify children whose health is rapidly deteriorating. This initiative responds to growing concerns over lengthy waits and inadequate care in hospital corridors, a problem publicly acknowledged by Health Secretary Yvette Cooper. She has committed to ending the practice of “corridor care” for seriously ill children, highlighting the urgent need for improved patient management in busy NHS settings.

The National Paediatric Early Warning System (PEWS) requires medical staff to regularly assess and record vital signs such as blood pressure, heart rate, and oxygen saturation. These measures are then scored to determine the urgency of intervention needed; a high score signals that a child requires prompt attention. Besides clinical indicators, any worries expressed by staff, family members, or the children themselves must immediately trigger escalation in care, ensuring no signs of decline are overlooked.

This safety measure is particularly crucial as the NHS braces for increased winter pressures when emergency departments often see a surge in patient numbers. Cooper referenced a tragic case to underscore the system’s importance: two-year-old Finlay Roberts died after enduring several hours in a crowded hospital corridor before being discharged. Cooper expressed a heartfelt apology to Finlay’s family, stating, “No child should be treated in a corridor. No patient should be treated in a corridor.” The hospital involved, Whittington Health NHS Trust, acknowledged the immense strain on their emergency services, which at times results in temporary clinical areas being used, including corridors.

The new early warning tool builds on existing systems for adults already employed in emergency and inpatient wards across the country, including those used for conditions like sepsis. Over 90 hospitals have already implemented PEWS within paediatric wards, employing age-appropriate assessment methods ranging from infants to teenagers. Furthermore, the NHS plans to roll out an expanded version of “Martha’s Rule,” which empowers patients, families, and carers to demand urgent reviews if they fear a patient’s condition is worsening and their concerns are not being addressed promptly. Named after Martha Mills, a 13-year-old girl who tragically died in hospital due to sepsis after staff missed signs of deterioration, this rule introduces a dedicated emergency phone line in A&E departments to facilitate rapid intervention when needed.

Duncan Burton, the chief nursing officer for England, described the new system as a vital advancement in paediatric care, especially under the pressures of busy emergency departments. He emphasized the necessity for frontline staff to swiftly detect when a child’s condition is worsening, stating, “This standardised approach will help them recognise the warning signs, communicate concerns, and make timely decisions when every moment matters.” PEWS is a collaborative effort between NHS England, the Royal College of Paediatrics and Child Health, and the Royal College of Nursing, aiming to improve outcomes for children and young people now and in the future