Development of a hospital early warning score to end 'escalation fatigue'

The Antrim Area Hospital Early Warning Score (HEWS) is an innovative method of assessing the level of pressure on an acute hospital site. It combines eight indicators to produce a score from 0 to 49, which is mapped to an escalation category, ranging from low to extreme pressure. The top two categories, 'severe' and 'extreme', have a corresponding range of escalation actions across service areas. This article explains why the Antrim Area HEWS was developed and the issues it sought to address, including 'escalation fatigue' among staff because of the normalisation of high alert status. The article includes an analysis of Antrim Area HEWS data collected over one year. It discusses the benefits of the Antrim Area HEWS including: the provision of a simple, objective method for assessing site pressure; increased awareness of site pressure among various service areas; enhanced staff support and understanding of the need for effective escalation; and the development of a focused and meaningful approach that has overcome the escalation fatigue associated with previous escalation frameworks.