New alert system for acute hospitals

A new early warning system to be implemented in all acute hospitals will help reduce deaths from cardiac arrest and complications such as sepsis, and will improve medical outcomes, senior medical figures said today.

The first ever National Clinical Guideline – the National Early Warning Score (News) – was officially unveiled by Minister for Health James Reilly today. It has already begun operating for adult patients in 80 per cent of acute hospitals and will be in place in the remainder by the end of the year.

The system involves a 'score card' which will be carried by all nursing and medical staff, and also eventually by ambulance staff. It will use the regular observations made on patients to create a 'score' which will then trigger an early alert if the condition of a patient is found to be deteriorating, so that they may receive the appropriate intervention.

It is the first such nationally mandated early-warning system in the world, according to the National Clinical Effectiveness Committee responsible for its introduction.

Dr Reilly said the warning system would help to reduce deaths and would improve medical outcomes. It would inform patients about the care they should be receiving and empower them to make informed healthcare choices.

"It's not just about knowledge for those who have to care for our patients but for those who receive the care to be able to question and query what's happening and why what they believe what should be happening isn’t happening."

The new standard meant that a doctor or nurse previously working, for example, at St Vincent's Hospital in Dublin but now working in Tralee, would be operating the same system for scoring patients and for triggering early warnings.

Prof Garry Courtney (co-sponsor for the national early warning score project and national clinical lead, National Acute Medicine Programme HSE, said medical patients occupied about half of all bed days in the acute sector and accounted for two thirds of costs.

The "unique and groundbreaking" alert system could save lives, he said. It would quickly help to identify if patients were in the wrong area and deteriorating so they could be moved to the correct area for treatment. It would help detect sepsis, which was probably one of the major causes of death in the health world.

He said doctors were "actually very good at treating sepsis" and there were very good outcomes. But it was difficult to detect.

Dr Tony Holohan, chief medical officer of the Department of Health, said the new guideline would bring benefits for the safety and quality of services delivered in hospitals.

He noted there had been "a number of significant patient safety incidents” in recent years and that there had been investigations into those.

"What this report clearly does is demonstrate a commitment to applying the learning that has arisen from those incidents."

He said the Minister, through the HSE board, would demand a statement on the implementation of the new warning system from the chief executives of the acute hospitals every year.

Private hospitals will also be expected to put a similar warning system in place once a licensing system is in place and they come under the remit of the Health Information and Quality Authority.

Eilish Croke, national lead for the National Early Warning Score, confirmed the alert system had been in place in the acute area of Galway University Hospital.

Asked about the case of Savita Halappanavar, who died at the hospital in her 17th week of pregnancy last October, Ms Croke said she would not comment on individual cases.

An autopsy carried out on Ms Halappanavar's body found she died of septicaemia "documented ante-mortem" and E.coli ESBL.

Michael Turner, the HSE's national clinical programme director for obstetrics and gynaecology, said today: “The national early warning system can’t be just taken off the shelf and applied to the pregnant patient for two reasons.

"First of all you have to take account of physiological changes in pregnancy and secondly we have to look after two patients at the same time, in the case of twins, three patients."

Prof Turner said plans were "well advanced" to introduce what would be known as the Irish Maternity Early Warning System in the first quarter of this year.

He said the system had to be customised to the pregnant patient. The News system had, however, been recommended for all gynaecological patients in the country.

The News guideline is the first to be produced by the National Clinical Effectiveness Committee which was established as part of the Patient Safety First initiative in September 2010.

Dr Reilly was joined at the Department of Health by Dr Holohan and by Prof Hilary Humphreys, chair of the National Clinical Effectiveness Committee, Prof Garry Courtney, co-sponsor for the News project and national clinical lead of the National Acute Medicine Programme, Eilish Croke, national lead for the News project.