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Case for change: a standardised inpatient paediatric early warning system in England
  1. Damian Roland1,2,
  2. Philippa Anna Stilwell3,
  3. Peter-Marc Fortune4,
  4. John Alexander5,
  5. Simon J Clark6,
  6. Simon Kenny7
  1. 1SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
  2. 2Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3General Paediatrics, Evelina Children's Hospital, London, UK
  4. 4Paediatric Intensive Care Unit, Royal Manchester Children's Hospital, Manchester, UK
  5. 5Child Health, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  6. 6Jessop Wing, Neonatal Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  7. 7Department of Paediatric Surgery, Alderhey Children’s NHS Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Damian Roland, SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, LE1 7HA, UK; dr98{at}


Most children in hospital who are clinically deteriorating are monitored regularly, and their treatment is escalated effectively. However a small, but significant, number of deteriorating children experience suboptimal outcomes because of a failure to recognise and respond to acute deterioration early enough leading to unintended harm. Tragically this occasionally can have fatal consequences. Investigations into these rare events highlight common themes of missed early signs of deterioration in children, prompting regulatory agencies to suggest paediatric early warning systems (PEWS) to aid clinical practice. In England, track and trigger tools (TTT), which are one facet of PEWS have been widely rolled out but in a heterogeneous fashion. The evidence for TTT is mixed but they are complex interventions and current outcomes do not fully define the entirety of their potential impact. This article explains the rationale behind the decision of the NHS England and NHS Improvement, Royal College of Paediatrics and Child Health and Royal College of Nursing to implement a standardised inpatient PEWS as part of a system-wide paediatric observations tracking system in England and how this fits into a wider programme of activity.

  • health services research
  • resuscitation

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  • Contributors The first draft of this paper was written by DR based on a version of a strategy document edited by PAS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Authors are all members of the National SPOT delivery board.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Data availability statement Survey results are available via reference 21

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