In patient safety, recognising risk is only the beginning. What matters is how quickly healthcare teams recognise deterioration, communicate concerns and respond appropriately.
This is where the Early Warning Score (EWS) plays an important role.
Early Warning Scores provide healthcare teams with a standardised way to monitor changes in a patient's physiological condition, helping identify deterioration before a patient becomes critically ill. This can support earlier intervention and escalation for serious conditions, including sepsis.
Sepsis affects an estimated 245,000 people in the UK each year and is associated with around 48,000 deaths — equivalent to approximately five deaths every hour. In the United States, at least 1.7 million adults develop sepsis annually, with at least 350,000 dying during hospitalisation or being discharged to hospice. Research published in JAMA Network Open found that around 1 in 8 sepsis-associated deaths reviewed were potentially preventable through better hospital-based care, highlighting the importance of timely recognition and appropriate clinical response.
Understanding Early Warning Scores (EWS)
An Early Warning Score (EWS) is a clinical tool used by hospitals to identify deteriorating patients before they become critically ill. By monitoring changes in vital signs, EWS enables earlier clinical intervention, supports rapid escalation of care and improves outcomes for conditions such as sepsis.
Typically, this involves assessing seven physiological parameters—respiratory rate, oxygen saturation, supplemental oxygen temperature, systolic blood pressure, heart rate, and level of consciousness — and assigning a score to each vital sign. The aggregated score is used to identify whether the patient is at risk of deterioration or not. It also empowers healthcare teams to take decisive actions such as initiating closer monitoring, adjusting medication, or activating a rapid response.
The Transformative Potential of Early Warning Scores
Integrating Early Warning Scores into Sepsis and Patient Care is crucial in transitioning from reactive to proactive healthcare delivery. While enhancing patient outcomes and improving the overall efficiency and effectiveness of the healthcare system at large, it also contributes to:
Timely identification and intervention: As discussed earlier, the most significant advantage of the EWS system is the ability to detect subtle changes in a patient's condition, which might otherwise be overlooked, in the early stages. This allows healthcare providers to promptly intervene and prevent further patient deterioration, which is arguably one of the most critical steps in the early management of sepsis.
Standardisation of care: Implementing a standard EWS system, such as NEWS (National Early Warning Score), assures standardisation of care practices across various healthcare settings. This, in turn, allows providers to ensure consistency in assessing patient status and initiating appropriate interventions, which mitigate variability and reduce the likelihood of errors.
Data-driven decision-making: Key to elevating patient care, EWS systems provide objective criteria that healthcare providers can use to assess patients' conditions in real-time and inform their decisions. This approach enhances clinical judgement by promoting evidence-based practice, ultimately improving patient outcomes.
Quality improvement initiatives: Data, trends, and outcomes obtained from the EWS system can be used by healthcare organisations to identify areas for improvement in patient care processes, such as better staff training, the implementation of digital quality management systems, and refining protocols. Implementing these initiatives can go a long way in preventing and managing adverse outcomes like sepsis.
EWS Governance Audits and Their Role In Sepsis Care
Early Warning Score (EWS) Governance Audits are assessments conducted to evaluate the effectiveness and adherence to protocols regarding the implementation and use of EWS in healthcare settings. They primarily focus on:
Whether EWS protocols include specific criteria for identifying patients at risk of sepsis
Whether healthcare staff are trained to recognise the signs of a deteriorating patient promptly
The effectiveness of protocols for escalating care and initiating appropriate interventions
Documenting vital signs, interpreting EWS scores accurately, and following predefined pathways for sepsis assessment and treatment
Whether there are clear processes in place for communicating EWS scores, escalating concerns, and activating rapid response or sepsis teams when necessary
MEG's Deteriorating Patient Bundle
To help organisations with their quality assurance process for patient deterioration, we've compiled a collection of assessments and audit tools, including various Early Warning Score forms such as standard, paediatric, maternity, and emergency medicine, each tailored to specific patient populations. The bundle also includes associated escalation pathways following the ISBAR model.
These are governance audits that organisations can use to ensure that their processes are working as designed and that staff are following the necessary protocol to prevent patient deterioration and the likelihood of events such as sepsis.
It also comes with a Quality Improvement Plan (QIP) tool to identify and address any issues or gaps in the assurance process. To see the tool in action, reach out to our team.
Turn EWS Audit Findings into Improvement
Identifying a problem is only valuable if it leads to action.
MEG connects EWS governance audits with Action Planning, allowing healthcare organisations to identify gaps in the assurance process, assign improvement actions, monitor ownership and track progress through to completion.
Organisations can also connect audit activity with related incidents, risks, policies and performance reporting through the wider MEG Quality Management platform.
This helps teams move from measuring compliance to demonstrating continuous quality improvement.