A report by the Royal College of Emergency Medicine (RCEM) has found that one in three NHS emergency departments throughout the UK does not have a formal system in place for scoring, recording and alerting doctors to a deterioration in a child’s health.
Children who arrive at NHS emergency departments with a medical illness, rather than an injury, are supposed to have their vital signs - temperature, breathing, blood pressure and heart rate - checked and recorded within 15 minutes of arriving. Abnormal vital signs are supposed to result in a further check within one hour.
The RCEM recommends that doctors use the Paediatric Early Warning Scores System, or an equivalent early warning system, to record results and has warned that, as many young patients are unable to communicate their symptoms, recording vital signs in a standardised manner is an important aspect of patient care.
However, the RCEM found that 30% of hospitals are not using a standardised scoring system and concluded that “there is a need for increased documentation of both initial and repeat vital signs” within the appropriate timeframes.
Dr Criddle, chairman of the Royal College of Paediatrics, said: “Sometimes there can be underlying issues which can go unrecognised if vital signs are not recorded – sometimes with grave consequences… all children should receive an initial assessment within 15 minutes of arrival to ensure we minimise the likelihood of missing serious illness.”
Arran Macleod, a solicitor in the Penningtons Manches clinical negligence team, commented: “We regularly act for clients who have attended emergency departments with seemingly innocuous symptoms but go on to present with far more serious illnesses than their symptoms initially suggested.
“As the RCEM and Dr Criddle make clear, the best practice to avoid missing a serious illness is standardised and consistent record keeping of vital signs. If there is inconsistent or incomplete documentation, or if examinations are not performed within appropriate time-frames, there is a risk that a serious illness will not be diagnosed when it should be and the outcome may then be far worse.”