Duncan Burton, Chief Nursing Officer for England

NHS England is introducing the National Paediatric Early Warning System, known as Pews, in accident and emergency departments across England from this winter. The health service says the rollout will make it the largest standardised scoring system of its kind in the world. The tool has until now been used only for hospital inpatients, and it is designed to help staff recognise sooner when an acutely ill child is getting worse.

More than six million children attend A&E in England each year. Doctors and nurses using Pews will measure and record each child's heart rate, blood pressure, breathing rate, oxygen levels and level of consciousness, then compare the readings with charts calibrated for age. The charts reflect what counts as abnormal at different stages of childhood, from babies to young people, and the scheme has been built specifically for emergency departments, where decisions must be made quickly and teams are often working under heavy pressure. A high score flags that a child is deteriorating and needs more urgent attention.

The score does not stand alone. NHS England said Pews is not intended to replace professional judgment or the views of parents, carers and children themselves. A concern raised by a family or by clinical staff can trigger an immediate escalation of care even when a child's score is low.

Duncan Burton, chief nursing officer for England, said staff in fast-paced emergency departments need to spot quickly when a child's condition is worsening. He said the standardised approach will help them recognise warning signs and make timely decisions "when every moment matters". He added that the system ensures the concerns of children and their families are heard and can prompt action.

The inpatient version of Pews is already in use in more than 90 hospitals in England. NHS England said data from those sites suggest consistently lower rates of cardiac arrest among patients. A comparable early warning tool for adults is already used across NHS hospitals, and the extension of the paediatric system to emergency departments brings children's care into line with that approach.

The Royal College of Paediatrics and Child Health worked on the new system. Dr Mike McKean, its vice-president for policy, said he was delighted to see the initiative launched ahead of winter, which he described as always a busy and challenging period for hospitals. He said the emergency department charts will support paediatricians and wider child health teams in spotting deterioration, and that, together with training and resources, they will help teams across England improve equity and patient safety.

The Royal College of Nursing also contributed to the work. Professor Lynn Woolsey, speaking for the college, said early escalation is critical for keeping children safe and described the system as a vital tool for nursing staff. She said the emphasis on listening to children and their families is especially important, and that a standardised approach across emergency departments and paediatric wards will support consistent assessment, communication and decision-making. She also said it will be crucial to ensure there are enough nursing staff, with sufficient capacity and the necessary training and support, to use the system effectively.

NHS England is separately drawing up new standards for how children are treated in A&E. Ending corridor care for children is a priority within that work. The standards and the early warning charts address different parts of emergency paediatric care, and both are intended to give departments a clearer framework for looking after the youngest patients.

The emergency department charts will be introduced from this winter, building on the experience of the hospitals that have used the inpatient system. NHS England and the two royal colleges have each pointed to training for frontline staff as the means by which the tool will reach its full effect in busy departments.