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Purpose

– The purpose of this paper is to increase understanding of how patient deterioration is detected and how clinical care escalates when early warning score (EWS) systems are used.

Design/methodology/approach

– The authors critically review a recent National Early Warning Score paper published in IJHCQA using personal experience and EWS-related publications, and debate the difference between detection and escalation.

Findings

– Incorrect EWS choice or poorly understood EWS escalation may result in unnecessary workloads forward and responding staff.

Practical implications

– EWS system implementers may need to revisit their guidance materials; medical and nurse educators may need to expand the curriculum to improve EWS system understanding and use.

Originality/value

– The paper raises the EWS debate and alerts EWS users that scrutiny is required.

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