Thanks again for the feedback you gave me a few weeks ago. I took your comments seriously, especially around composite scoring versus evaluating vitals individually.

Since then, I've expanded the system quite a bit:

• Implemented NEWS2 scoring using respiratory rate, oxygen saturation, systolic blood pressure, heart rate, consciousness level (AVPU), temperature, and supplemental oxygen use. The system now generates risk-based alerts from a composite score rather than relying only on individual threshold breaches.

• Added qSOFA scoring alongside the existing SIRS-based sepsis detection. Both systems now run independently and can trigger sepsis-related alerts.

• Expanded the observation model to include systolic BP, diastolic BP, AVPU, supplemental oxygen, lactate, and glucose, which were missing previously.

• Added trend detection so the system can identify rapid deterioration even when a patient hasn't crossed a critical threshold yet.

• Added alert suppression windows to reduce alert fatigue. Warning-level alerts can be temporarily suppressed after acknowledgment, while critical alerts are never suppressed.

• Added clinical orders and automated sepsis bundle tracking. When a sepsis-related alert fires, the system automatically creates a sepsis bundle and tracks completion of blood cultures, lactate measurement, antibiotics, and IV fluids against a one-hour compliance target.

The project has evolved from a threshold-based monitoring system into more of a clinical surveillance and early warning platform.

My next planned step is building a patient simulator and virtual ward dashboard so clinicians can interact with the system and evaluate it in realistic scenarios rather than just reviewing the backend design.

I'd be interested in hearing whether these changes move the system closer to how a real early warning platform should behave and what you think would still be missing.