Kevin Cairney and Elaine Clancy explain how a site practitioner early warning system can alert urgent care staff to problems with capacity and patient flow

Overcrowding due to poor patient flow increases risk for more than 500,000 patients a year (College of Emergency Medicine (CEM) 2014) and is linked to increased mortality (Geelhoed and de Klerk 2012). CEM (2014) has called for urgent action to address ‘exit block’ in UK emergency departments (EDs). In October last year, Croydon Health Services NHS Trust designed and implemented a site practitioner early warning system (SPEWS) to alert staff to capacity and flow pressures in the ED, and to initiate escalation to a nurse-led, protocol-driven response. Under pressurised and time-critical conditions, SPEWS ensures rigour and conformity in exchanges between clinical emergency care staff and managers. The result is closer collaboration between clinicians and managers, optimised patient flow and mitigated risk from exit block.