Deterioration Early Warning System (DEWS) recommended for use in aged residential care

A feasibility study supports the use of a new early warning system to help staff working in aged residential care (ARC) recognise when a resident may be getting acutely unwell and respond early.     

 Nationally and internationally, vital-sign based track and trigger early warning systems have been shown to improve patient safety, reducing in-hospital mortality and the need for intensive care admissions. The Deterioration Early Warning System (DEWS) was developed in Aotearoa New Zealand using evidence and input from the ARC sector. 

 In 2024, five ARC facilities in Aotearoa participated in a study to test the feasibility of DEWS. 

The ‘Aged Residential Care Deterioration Early Warning System (DEWS) Feasibility Study’ released today found that those who took part recommend the use of this new tool. 

 Background on DEWS

Older people, particularly those with age-related disability or frailty, can often display symptoms which don’t reflect a sudden and serious deterioration in their condition. 

DEWS supports staff working in ARC to recognise when a resident may be getting acutely unwell and to respond early. It was developed and designed by Julie Daltrey (PhD candidate, University of Auckland) and Michal Boyd (Associate Professor, University of Auckland) with support from Ageing Well National Science Challenge, Ministry of Business, Innovation & Employment. 

DEWS provides a structured framework for resident assessment, identifying combinations of observable and clinical signs that suggest deterioration, assessing clinical urgency, and a standardised communication tool for escalation. 

DEWS feasibility study and findings

Julie Daltrey, Michael Boyd and the Improved Service Delivery team from Te Tāhū Hauora Health Quality & Safety Commission saw an opportunity to collaborate to conduct a feasibility study of DEWS in the ARC sector - meaning the tools could be tested and revised without having to commit to practice changes. 

The ‘Aged Residential Care Deterioration Early Warning System (DEWS) Feasibility Study’ examined whether DEWS could be implemented in ARC in Aotearoa and whether the sector felt it should be.    

DEWS was found to be effective in supporting the timely identification of and response to acute deterioration. Importantly, it supported critical thinking, effective communication and clinical accountability, as well as increasing staff confidence in those skills.  

The study found that the implementation of DEWS in ARC is feasible, and its use is supported by strategic and clinical leaders in the sector as well as frontline care providers.  

The feasibility study report also provides key recommendations for future development provided by the ARC facility staff that participated in the study.  

Acknowledgements 

We would like to acknowledge the significant work and feedback from everyone who was involved in the development and testing of DEWS. In particular, Julie Daltrey, Michal Boyd, and the Improved Service Delivery team who worked directly with the five ARC facility project teams throughout 2024 to test, refine, and evaluate DEWS.  

The Improved Service Delivery team is currently developing plans to support wider DEWS implementation across the ARC sector. 

Read the ‘Aged Residential Care Deterioration Early Warning System (DEWS) Feasibility Study’