West Hertfordshire Teaching Hospitals NHS Trust
Supporting three hospitals
Deteriorating patient alerts
reduction in unplanned ICU admissions (10% to 2.3%) from AAU
of staff reporting improved communication and escalation speed
of high alerts acknowledged within clinical target times
West Hertfordshire Teaching Hospitals NHS Trust partnered with Alertive to transform how deteriorating patients are escalated and responded to, replacing fragmented legacy processes with a real-time digital escalation pathway and EPR integrated automated alerts. This initiative was also shortlisted for the 2025 HSJ Patient Safety Awards and 2026 HSJ Digital Awards.
Escalation of deteriorating patients across the Trust was inconsistent, delayed, and heavily reliant on outdated communication systems.
Between March 2024 and March 2025, 13 safety incidents were linked to missed or delayed escalation. Despite 37,275 elevated NEWS2 scores, only 7,000 were formally escalated, highlighting a significant gap in response.
Staff feedback reinforced these concerns, with 40% believing escalation responses were delayed and 30%reporting that delays were frequent. Half of respondents were unsure whether action had been taken, while 35% found it difficult to contact the correct responder.
These challenges were compounded by fragmented bleep based communication, unclear accountability, and cultural barriers when escalating to senior colleagues, all of which reduced confidence in escalation, particularly among junior staff.
In early 2025, WHTH launched a 35-day pilot of Alertive in the Acute Assessment Unit to digitise NEWS2 escalation and response pathways.
Alertive was integrated directly with the Electronic Patient Record, enabling automatic generation of alerts within 60 seconds of a qualifying NEWS2 score being recorded. These alerts were delivered as secure, digital, and fully auditable messages to clearly defined clinical roles, including the Bay Nurse, Nurse in Charge, and Critical Care Outreach Team.
The pathway was co-designed with multidisciplinary stakeholders, including CCOT, Sepsis CNS, Hospital at Night, and Resuscitation teams, alongside governance teams and patient representatives.
Key design principles included:
Deputy Director of Nursing
When time isn’t on our side, our systems must be. Escalation shouldn’t be another hurdle. It should be the safety net it was always meant to be.
Senior Charge Nurse & Team Leader
Now with Alertive, the right people get alerts straight away so the patient can get the right care at the right time.
The pilot demonstrated clear improvements in responsiveness, safety, and staff confidence across the Acute Assessment Unit.
The average response time to high-priority alerts was reduced to 344 seconds (just under 6 minutes), with all non-test high alerts acknowledged within the 15-minute clinical target. Across the pilot, the system generated an average of 12 high and 19 medium alerts per shift, improving visibility of patient deterioration in real time.
Key improvements included:
Following the success of the pilot, WHTH is now expanding the use of Alertive across the Trust, including rollout to Consultants and Resident Doctors.
Phase 2 will also extend the system into Maternity and Paediatrics, including nPEWS integrations and interoperability with BadgerNet.
Ongoing monitoring will continue through clinical audits, performance data, and staff feedback, alongside academic evaluation of the impact of digital escalation on patient outcomes and workforce experience.
