This is a secondary driver from safe clinical and care processes for reliable recognition of deterioration and standardised structured response within the Deteriorating Patient driver diagram
Change ideas
The examples below show how this secondary driver can be implemented in practice. Additional change ideas can be found in the Deteriorating Patient driver diagram
- Practitioner: Use of “Special Instructions” within NEWS2 to reflect individual physiological baseline
- Team: Reliable process for timely recording of observations and NEWS2 scoring to support early identification of physical deterioration
Evidence and resources
- Ede J, Hutton R, Watkinson P, Kent B, Endacott R. Improving escalation of deteriorating patients through cognitive task analysis: understanding differences between work-as-prescribed and work-as-done. Int J Nurs Stud. 2024;151:104671.
- Royal College of Physicians. National Early Warning Score (NEWS) 2 [online]. 2017; Available from: https://www.rcp.ac.uk/resources/national-early-warning-score-news-2/
- Public Services Delivery Scotland. National early warning score (NEWS) in NHS Scotland [online]. 2025
- Scottish Intercollegiate Guidelines Network. SIGN 167: care of deteriorating patients. A national clinical guideline [online]. 2023
- UK Government. Equity in medical devices: independent review – final report – GOV.UK [online]. 2024
- Velh N, Ridderikhof ML, Bergsma L, et al. Performance of early warning and risk stratification scores versus clinical judgement in the acute setting: a systematic review. Emerg Med J. 2022;39:918-23.