Intended for healthcare professionals


A national early warning score for acutely ill patients

BMJ 2012; 345 doi: (Published 08 August 2012) Cite this as: BMJ 2012;345:e5310
  1. Ann McGinley, consultant nurse1,
  2. Rupert M Pearse, clinical reader2
  1. 1Critical Care Outreach Service, Royal London Hospital, Barts Health NHS Trust, London UK
  2. 2Barts and the London School of Medicine and Dentistry, Queen Mary’s University of London EC1M 6BQ, UK
  1. r.pearse{at}

A new standard to help identify patients in need of critical care

The critical care unit, which clusters patients with life threatening illness in a single geographical area, is now a familiar concept. It offers patients the best chance of survival through optimum technology and the concentration of clinical skills and experience. Critical care medicine is a specialty that depends largely on a resource intensive environment. Until recently, for both economic and practical reasons, critical care could not be provided for every hospital inpatient. As the specialty has developed, it has repeatedly been noted that poor outcomes commonly result from a failure to promptly recognise and treat patients who become acutely ill on a standard hospital ward. As part of a long term strategy to tackle this problem, the Royal College of Physicians has launched a national early warning score.1 This is a welcome development that may be good news for patients. However, it is worth highlighting some potential pitfalls.

Patients die not from their disease but from the disordered physiology caused by the disease. The early warning score is an established tool that uses this concept …

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