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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