The National Health Service in England is introducing the Paediatric Early Warning System (Pews) across accident and emergency departments this winter, marking the first time the tool will be used in A&E settings. The rollout will make Pews the world’s largest standardised scoring system of its kind when fully implemented across England’s A&E departments.
Pews operates through a scoring system that assesses vital signs including blood pressure, heart rate, breathing rates, oxygen levels and consciousness. The system uses age-appropriate charts designed to identify abnormal signs of deterioration specific to babies, children and young people. A high score alerts medical staff when a child’s condition is worsening, though NHS officials emphasised the system is not intended to replace clinical judgment or input from parents, carers and children regarding the patient’s status. Even low scores can trigger immediate escalation of care if staff identify concerning signs.
The early warning system has been adapted specifically for the rapid decision-making environment of busy emergency departments. More than 6 million children attend A&E across England annually. Pews has already been in use for inpatient hospital care, with data indicating that more than 90 hospitals using the inpatient system have consistently experienced lower rates of cardiac arrests among their patients. A comparable system for adults, the National Early Warning System, is already established in NHS hospitals.
Duncan Burton, chief nursing officer for England, stated that the standardised approach will help staff recognise deterioration warning signs and make timely decisions in fast-paced emergency settings. Medical leaders from the Royal College of Paediatrics and Child Health and Royal College of Nursing, both involved in developing the A&E version, highlighted that the system supports patient safety and equity in care while emphasising the importance of listening to children, parents and carers. Separately, NHS England is developing new standards for A&E treatment of children, including prioritising the elimination of corridor care for young patients.
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