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Early warning scores to detect deterioration in COVID-19 inpatients


The national investigation

This national intelligence report provides insight into a safety risk when using early warning scores to detect deterioration in patients with coronavirus (COVID-19) on general hospital wards.

Our national intelligence reports provide insight into current patient safety risks identified by HSIB. They include analysis and key information for consideration by relevant stakeholders to facilitate a response. When appropriate, our national intelligence reports include safety observations and safety actions.

Investigation summary

A safety risk was identified based on a referral to HSIB. The referral was about difficulties in identifying clinical deterioration in patients with COVID-19 on general hospital wards.

Early warning scores

The standard national early warning score - NEWS2 - is in widespread use across the NHS. NEWS2 gives a numerical aggregate score gathered from certain physiological parameters including:

  • Respiration rate
  • Oxygen saturation
  • Systolic blood pressure
  • Pulse rate
  • Level of consciousness or new confusion
  • Temperature

NEWS2 has been shown to be valuable in detecting deterioration when used in conjunction with clinical judgement.

Report purpose

The Royal College of Physicians (RCP) is responsible for the development of early warning scores for clinical deterioration and this report documents how concerns raised by HSIB were responded to.


The RCP released a statement on its website relating to revised guidance on the use of early warning scores for COVID-19 inpatients.

The RCP suggest that all staff should be aware that any increase in oxygen requirements should be an indicator of clinical deterioration as the early warning score might not significantly increase.

Read the full report