A&Es in England Get a New Early-warning Score for Sick Children This Winter

What is changing

NHS England announced on 2 November that the national Paediatric Early Warning System (PEWS) will be used in A&E departments from this winter. It is already used for children on hospital wards in more than 90 hospitals, and NHS England says the data suggests consistently lower rates of cardiac arrest where it is used. It is the first time it will be used in emergency departments, and NHS England describes it as the largest standardised scoring system of its kind in the world. More than 6 million children attend A&E in England each year.

How the score works

Staff record a set of vital signs and each one adds to a score. A rising score prompts a faster review by a senior clinician. The checks are:

• heart rate
• breathing rate
• blood pressure
• oxygen levels
• level of consciousness

There are separate, age-appropriate charts for babies, children and young people, because a normal heart or breathing rate for a baby would be worrying in a teenager. Adults have an equivalent system, called NEWS.

Parents' concerns count

The score does not replace a clinician's judgement or what parents notice. Family concerns can trigger escalation even when the score is low. Health Secretary Yvette Cooper said: "if a parent says something isn't right, they will be listened to."

What to do if you are worried in A&E

• Tell the nurse looking after your child clearly what has changed: "He has stopped drinking", "She is much sleepier than an hour ago".
• If you still feel unheard, ask for the nurse in charge or a senior doctor to review your child.
• For an emergency outside hospital, call 999. For urgent advice that is not an emergency, call NHS 111.

The caveats

The Royal College of Nursing's Professor Lynn Woolsey warned that a scoring system only works with enough staff to act on it. NHS England is also drawing up urgent standards for children in A&E, including ending corridor care. This system applies to England; Scotland, Wales and Northern Ireland run their own health services.

This article explains a policy announcement. It is not medical advice. If you are worried about a child, contact a health professional.

How we wrote this: our staff read the reporting listed below, checked the facts against more than one source where possible, and wrote this piece in our own words. Anything not confirmed is labelled. Spotted a mistake? Tell us.