A nurse-driven adult early warning system for inpatients age 21 and older at a children's hospital can be achieved through a standardized EWS assessment process, incorporation into the electronic health record, and charge nurse and key stakeholder oversight. Furthermore, implementation of an adult EWS being used at a pediatric institution and our distribution of NEWS values were comparable to distribution published from adult hospitals.

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BACKGROUND AND OBJECTIVES: Hospital-associated venous thromboembolism (HA-VTE) is a leading cause of preventable in-hospital mortality in adults. Our objective was to describe HA-VTE and evaluate risk factors for its development in adults admitted to a children's hospital, which has not been previously studied. We also evaluated the performance of commonly used risk assessment tools for HA-VTE. METHODS:A case-control study was performed at a freestanding children's hospital. Cases of HA-VTE in patients $18 years old (2013-2017) and age-matched controls were identified. We extracted patient and HA-VTE characteristics and HA-VTE risk factors on the basis of previous literature. Thrombosis risk assessment was performed retrospectively by using established prospective adult tools (Caprini and Padua scores).RESULTS: Thirty-nine cases and 78 controls were identified. Upper extremities were the most common site of thrombosis (62%). Comorbid conditions were common (91.5%), and malignancy was more common among case patients than controls (P 5 .04). The presence of a central venous catheter (P , .01), longer length of stay (P , .01), ICU admission (P 5 .005), and previous admission within 30 days (P 5 .01) were more common among case patients when compared with controls. Median Caprini score was higher for case patients (P , .01), whereas median Padua score was similar between groups (P 5 .08).CONCLUSIONS: HA-VTE in adults admitted to children's hospitals is an important consideration in a growing high-risk patient population. HA-VTE characteristics in our study were more similar to published data in pediatrics.

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