Early Warning Scores (EWS) are used as part of the afferent limb system in a Rapid Response System (RRS) to trigger a medical response when patients in the general wards show early signs of deterioration (Gerry et al., 2020). EWSs are, in most cases, scores that are calculated using a limited set of the patient’s vital signs and have been previously validated to predict patient death, Cardiopulmonary Resuscitation (CPR), and Unplanned Intensive Care Unit (ICU) admissions (Gerry et al., 2020). Their goal is to standardise patient observations using an EWS and by doing so create a ‘safety net’ to detect deterioration early. When early deterioration is detected, nurses and/or physicians with critical care experience can reach out to the general ward, bringing their expertise to the patient in need (DeVita et al., 2017). Currently, the best performing EWS is the National Early Warning Score (NEWS) which was developed by the Royal College of Physicians (UK) and repeatedly externally validated (Brink et al., 2019, Hargreaves et al., 2020, Rcop, 2017, Sabir et al., 2021, Vergara et al., 2021). If an RRS is implemented effectively, patients in the general ward will be treated early or are receiving end-of-life care therefore possibly reducing the number of late unplanned ICU admissions and the length of stay on the ICU (Subbe et al., 2019). EWSs such as the NEWS seem to be good-performing screening instruments (Haegdorens et al., 2020). However, the NEWS guideline stresses that concern about a patient’s clinical condition should always override the NEWS if the attending healthcare professional considers it necessary to escalate care (RCOP, 2017).

In previous research, we developed and validated a new scale to aid nurses in measuring patient deterioration through nurse intuition in medical and surgical patients admitted to the general ward (Haegdorens et al., 2023). The Nurse Intuition Patient Deterioration Scale (NIPDS) was developed, piloted, psychometrically tested, and validated in this first study. The goal was to develop an instrument, based on current literature and expert review, that nurses could use at the patient's bedside and that includes clear predefined clinical cues. Additionally, we aimed for a scale that could be used for patients who could not (easily) respond to questions. The NIPDS seemed highly accurate in predicting physician assistance, resuscitation team calls, patient death, and unplanned transfers to the intensive/medium care unit within 24 h after registration using a threshold of ≥5. However, it remains unclear how the NIPDS performs compared to the NEWS to predict patient outcomes and if both scores could be used simultaneously to increase accuracy.