Accountability, Technology, and the Role of Nurses in Early Warning Systems

Written by Nedlyne Monestime

One of the main goals of contemporary healthcare is patient safety. Implementing early warning systems, like the UK National Early Warning Score 2 (NEWS2), is one attempt to standardize the detection of clinical deterioration to prevent preventable harm. To decrease the excessive intervention gap between observations and prompt actions, NEWS2 computes weighted data based on vital signs. It gives the clinician instructions on how to escalate the situation. By offering structured communication and decision support, these tools aim to reduce omission errors, especially in high-risk patient segments.

In my previous organization, a cancer center, the staff nurses could spot small changes in the deterioration before it became unmanageable and problematic by using NEWS2. For instance, to ensure that the nurses were not left to rely solely on their instincts or lack of, a higher score would not only warn them of a possible decline but also provide instructions on how to proceed. Although the clinical judgment was mandatory, the system offered standard precautions to all nurses at the bedside and enforced multidisciplinary institutionalization (Durr et al., 2022). In such a way, NEWS2 acted as a safety net and accountability tool, reducing the uncertainty of the decisions made.

However, the tragic case in Texas, On December 14, 2023, 11-year-old Nicholas Mata went to Methodist Southlake Medical Center with flu-like symptoms and was sent home after receiving fluids. When his condition worsened, with symptoms including fever, vomiting, rapid heart rate, and low blood pressure, he was taken back to the same ER on December 23. After a short stay, he was again discharged with a diagnosis of an upper respiratory infection, despite reportedly being too weak to walk.  Two days after his second ER visit, Nicholas was rushed to Cook Children's Medical Center, where he was admitted to the pediatric intensive care unit (PICU) with septic shock from a Group A strep infection.  The family filed a lawsuit in Tarrant County against Methodist Southlake and one of its doctors, accusing them of ignoring the boy's severe symptoms and discharging him improperly. Federal investigators also cited the hospital for violations of the Emergency Medical Treatment and Labor Act (EMTALA).What they have argued means that medical practitioners have failed to detect and intervene on indicators of sepsis early enough. This raises rustic questions: in case of a failed system of care, who is to blame? Is it the bedside providers, the organisation overall, or even the electronic health record (EHR) system that failed to warn about the risk?

Healthcare accountability researchers are leaning towards a system-style of thinking in which errors cease to be considered simply as an individual failure, but the failure of complex systems of technology, communications, and organizational culture. In this sense, nurses frequently find themselves in an intermediate position: they should act on patients' behalf and use tools such as EHRs or early warning systems that are not fully developed or integrated. It is risky to blame individual practitioners out of context of the system, which may reduce the willingness to open a discussion on how safety can be improved (Rodziewicz, 2024). Meanwhile, it is understandable that patients and families seek accountability when harm comes from avoidable omissions. A moderate strategy is thus required, an approach that recognizes the systemic weakness and holds responsible individuals fairly. This balance improves patient safety by fostering a learning culture rather than punishment.

In these situations, the use cannot be disregarded.

Clinical decision support and care documentation are the goals of the health information systems in use today. Delays in diagnosing sepsis can be facilitated by an EHR that lacks a powerful sepsis warning system or cannot integrate scoring systems like NEWS2. It has been demonstrated that the addition of automated alerts to electronic health records (EHRs) greatly aids in detecting sepsis and promptly implementing appropriate measures (NHS England, 2017). Thus, it makes sense to ask whether the technology fulfilled its intended purpose in the context of liability. Otherwise, it might not be only individuals who can be held accountable, but also vendors and health organizations that did not put in sufficient measures to protect them. All the stakeholders should share patient safety. In this regard, EHRs should be reviewed and enhanced continuously to preserve care delivery.

Nevertheless, the professional and ethical liability of nurses is a necessary component. Patient advocacy, vigilance, and the need to escalate concerns are supportive of nursing practice even in the presence of building systemic barriers. The idea is not that the nurses should never commit any mistakes, but that they should be critical when the patients' lives are at risk. Dresser et al. (2023) conducted a qualitative study showing that the perception of deterioration depends on nurses' knowledge and capability to observe minor alterations, process and interpret them, and react accordingly, despite systemic limitations. In cases such as the Texas case, the courts have to weigh the acknowledgement of the systemic failure against the professional role of the individual clinicians.

Conclusion

The safety of patients cannot be guaranteed through technology and individual vigilance, but both must be combined. The introduction of NEWS2 and other tools, such as those measures, emphasizes the significance of standardization, but it also demonstrates that tools are not as widely adopted. A shared liability must exist between the clinicians, institutions, and technology developers in the incidence of preventable harm. Nurses must not be accused of systemic breakdowns, which must also not be overestimated when advocating for the patient. The meaning behind this is not far-fetched, and this is that, surprisingly, patient safety can only be encouraged in an environment of shared accountability, undeniable training, and well-established early warning mechanisms to ensure that no indication of warning eludes. Oracle and Epic lets talk!

References

NHS England. (2017). NHS England» Our work on sepsis. England.nhs.uk. https://www.england.nhs.uk/ourwork/clinical-policy/sepsis/sepsis-work/

Durr, D., Niemi, T., Despraz, J., Tusgul, S., Dami, F., Akrour, R., Carron, P.-N., Le Pogam, M.-A., Calandra, T., & Meylan, S. (2022). National Early Warning Score (NEWS) Outperforms Quick Sepsis-Related Organ Failure (qSOFA) Score for Early Detection of Sepsis in the Emergency Department. Antibiotics, 11(11), 1518–1518. https://doi.org/10.3390/antibiotics11111518

Dresser, S., Teel, C., & Peltzer, J. (2023). Frontline Nurses' clinical judgment in recognizing, understanding, and responding to patient deterioration: A qualitative study. International Journal of Nursing Studies, 139, 104436–104436. https://doi.org/10.1016/j.ijnurstu.2023.104436

Rodziewicz. (2024, February 12). Medical Error Reduction and Prevention. https://pubmed.ncbi.nlm.nih.gov/29763131/