The NICE guidelines for managing the acutely ill hospital patient include a graded response strategy to be followed if a patient on a clinical ward deteriorates.
Requirement: locally approved early warning score (EWS)
Call code blue.
EWS triggered, high score
Emergency call to the emergency response team which should respond immediately; emergency call to the provider(s) caring for the patient.
EWS triggered, medium score
Urgent call to provider(s) caring for the patient; urgent call to a provider on call to respond to an acute illness
EWS triggered, low score
Increased frequency of observations; nurse supervisor alerted
EWS not triggered
routine monitoring by nursing staff
• It may be prudent to apply continuous monitoring systems to a patient with a low to medium EWS score.
• The response for an emergency and a high score on the EWS are usually similar. In a code blue anyone nearby may respond.
• There is a trade off between a graded vs all-or-nothing response strategy. A graded response strategy may take a bit more effort to compute but would result in fewer "false positive" calls to a response team.
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Purpose: To employ a graded response strategy for a hospitalized patient based on clinical status and results of the local early warning score (EWS).
Objective: severity, prognosis, stage, differential diagnosis and mimics, red flags, failure handling, when to refer