This guideline covers how patients in hospital should be monitored to identify those whose health may become worse suddenly and the care they should receive. It aims to reduce the risk of patients needing to stay longer in hospital, not recovering fully or dying. It doesn’t specifically cover the care of children, patients in critical care areas or those in the final stages of a terminal illness.
This guideline includes recommendations on:
- physiological observations to be recorded in acute hospital settings
- using physiological track and trigger systems to identify at risk patients
- response strategies for patients who are deteriorating
- transfer of patients from critical care areas to general wards
Who is it for?
- Healthcare professionals
- All adult inpatients, including patients in the emergency department being admitted to hospital and those being moved between departments
- Family and carers of adults in hospital
Is this guideline up to date?
We updated this guideline in April 2019 to include the national early warning score (NEWS2) endorsed by NHS England.
Guideline development process
This guideline was previously called acutely ill patients in hospital: recognition of and response to acute illness in adults in hospital.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.