A hand holding an electronic hand held device showing an example of an alert telling doctors to review a deteriorating patient
An electronic hand held device, which will be used at Alder Hey

Electronic hand held devices are being used to record patients’ vital signs at Alder Hey Children’s Hospital in the first research study of its kind in the UK as an early warning system for children.

Staff at Alder Hey are currently using the electronic devices to record breathing rate, effort of breathing, oxygen saturation, oxygen requirement, heart rate, blood pressure, capillary refill time, temperature and nurse or parental concerns.

The recorded data will automatically calculate an age-specific paediatric early warning score (PEWS), which categorises the risk of developing serious illness into low, medium, high or critical. These scores and signs suggestive of sepsis are automatically flagged to staff to help them recognise the early signs of deterioration, with a view to reducing emergency admissions to critical care.

The DETECT study (Dynamic Electronic Tracking and Escalation) to reduce Critical Care Transfers has been funded by a £1.25m grant awarded by the National Institute for Health Research Invention for Innovation Programme (NIHR i4i).

PEWS lead at Alder Hey Gerri Sefton said: “Developing an early warning system for children is much more complex than for adults.

“Children’s rate of breathing, heart rate and blood pressure alter significantly from birth to adulthood, so the model we use to judge how unwell a child is has to change with age. Children require five different age specific risk models, while adults have just one.”  

This technology automatically loads the correct age-specific PEWS risk model associated with the patient’s date of birth, by reading the barcode on their hospital ID band.

This is the first large study of its kind in children in the UK to evaluate the effectiveness of an electronic physiological surveillance system, incorporating both an age-specific Paediatric Early Warning Score (PEWS) and the National Institute for Health and Clinical Excellence (NICE) sepsis screening guidance.

It is a collaborative study involving partners from The University of Liverpool, Edge Hill University, Lancaster University and the healthcare IT company System C.

A head and shoulders shot of Bernie Carter wearing a white top and smiling slightly
Professor Bernie Carter

Professor Bernie Carter, Edge Hill University and co-applicant said “This study is both complex and fascinating and we hope that the implementation of the technology will support nursing care and improve the detection of and treatment of deterioration in children preventing the need for admission to critical care.”

The technology uses System C’s CareFlow Vitals software platform (formerly known as VitalPAC), which was shown to improve serious illness recognition and reduce deaths in adults. The system includes secure encrypted communications for health professionals.

Automated alerts are sent about the sickest children and concerns can be escalated direct to the clinical team, without the nurse leaving the patient’s bedside. Laboratory results are sent to devices to help to identify when a child might have sepsis, a serious illness associated with an overwhelming response to infection.

The early identification of clinical deterioration in children is an ongoing challenge across the NHS. Children cannot easily communicate that they are very unwell and rely on adults to notice the subtle signs. Children in hospital who become critically unwell and require emergency admission to critical care are sicker, need more intensive treatment and have a longer hospital stay compared to other admissions.

Professor Enitan Carrol from the Institute of Infection and Global Health at the University of Liverpool added: “Sepsis is a Department of Health priority, and the software platform will include prompts for the earlier recognition of sepsis, allowing implementation of time-critical interventions to improve outcomes in hospitalised children.

 “This will not only be beneficial for patients by targeting treatment earlier and reducing their stay in hospital, but should also prove cost-effective for the NHS.”

Programme director for i4i Martin Hunt said: “Finding faster, more effective ways to identify when young patients are becoming seriously ill is a major challenge – NIHR’s i4i programme funds the development of innovative technology to help solve healthcare problems like this and it’s exciting to see an already effective device for adults being adapted to help improve care for sick children.”

- Alder Hey Children's Hospital Press Office