Early warning scores: unravelling detection and escalation

PURPOSE: The purpose of this paper is to increase understanding of how patient deterioration is detected and how clinical care escalates when early warning score (EWS) systems are used. DESIGN/METHODOLOGY/APPROACH: The authors critically review a recent National Early Warning Score paper published in IJHCQA using personal experience and EWS-related publications, and debate the difference between detection and escalation. FINDINGS: Incorrect EWS choice or poorly understood EWS escalation may result in unnecessary workloads forward and responding staff. PRACTICAL IMPLICATIONS: EWS system implementers may need to revisit their guidance materials; medical and nurse educators may need to expand the curriculum to improve EWS system understanding and use. ORIGINALITY/VALUE: The paper raises the EWS debate and alerts EWS users that scrutiny is required.