Nurses’ role in detecting early and subtle signs of patient deterioration in acute hospitals

Early recognition of patient deterioration is essential for reducing preventable harm in the acute hospital. While early warning score systems such as the National Early Warning Score (NEWS) 2 standardise the way patients are assessed and monitored, they do not necessarily capture the full spectrum of cues which can alert healthcare professionals that a patient is deteriorating. Nurse intuition, non-numerical observations, family and patient concerns, and trends in vital signs, consciousness level and function all have a role as early markers of patient deterioration that may precede measurable physiological changes. This article presents the rationale for integrating these early and often subtle signs of deterioration in clinical practice alongside early warning scores, and proposes a framework that offers a structured way of doing so.