A preimplementation survey for a standardised approach to paediatric early warning systems

Wheway, Jayne; Stilwell, Philippa Anna; Cook, Adam; Roland, Damian

doi:10.1136/archdischild-2020-319100

Cited by 6 publications

(8 citation statements)

References 3 publications

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“…The first published Paediatric Early Warning Score in the UK was in 2005 with multiple iterations published since and nearly all hospitals in England now using some form of a score. 13 In a recent systematic review, our group examined 30 studies to determine the effectiveness of paediatric track and trigger tools (PTTT). 14 These studies were predominantly before and after studies using a variety of outcomes.…”

Section: Challenges With Determining Effectivenessmentioning

confidence: 99%

“…Certainly there is evidence from our qualitative examination of these systems that PEWS aid staff in having a common language for communication about deterioration 36. This might explain why PEWS have continued to spread13 37 despite equipoise on their utility and is a reason why national scores exist in Scotland and Ireland. The English National Health Service has started a schedule of activity to introduce a standardised inpatient PEWS chart 38.…”

Section: How Might Pews Function?mentioning

confidence: 99%

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Paediatric early warning systems: not a simple answer to a complex question

et al. 2022

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Paediatric early warning systems (PEWS) to reduce in-hospital mortality have been a laudable endeavour. Evaluation of their impact has rarely examined the internal validity of the components of PEWS in achieving desired outcomes. We highlight the assumptions made regarding the mode of action of PEWS and, as PEWS become more commonplace, this paper asks whether we really understand their function, process and outcome.

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Section: Challenges With Determining Effectivenessmentioning

confidence: 99%

Section: How Might Pews Function?mentioning

confidence: 99%

Paediatric early warning systems: not a simple answer to a complex question

et al. 2022

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“…They alert health professionals (HPs) to signs of a child’s deterioration, with the intention of triggering an urgent review and escalating care, as needed [ 9 ], and reducing emergency transfer to critical care, cardiac arrest and death [ 10 – 14 ]. Recording PEW scores can be paper-based or electronic [ 3 , 9 , 15 ]; e-scoring has advantages in comparison to paper-based scoring in terms of enhanced safety benefits including greater time efficiency, reduction in human error and instant availability of the recorded data [ 16 , 17 ]. There is a drive for PEWS to be embedded in the care of children in hospital [ 13 , 18 ], but in the UK their use is not consistent [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study

et al. 2022

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Background Paediatric early warning systems (PEWS) alert health professionals to signs of a child’s deterioration with the intention of triggering an urgent review and escalating care. They can reduce unplanned critical care transfer, cardiac arrest, and death. Electronic systems may be superior to paper-based systems. The objective of the study was to critically explore the initial experiences and perceptions of health professionals about the acceptability of DETECT e-PEWS, and what factors influence its acceptability. Methods A descriptive qualitative study (part of The DETECT study) was undertaken February 2020–2021. Single, semi-structured telephone interviews were used. The setting was a tertiary children’s hospital, UK. The participants were health professionals working in study setting and using DETECT e-PEWS. Sampling was undertaken using a mix of convenience and snowballing techniques. Participants represented two user-groups: ‘documenting vital signs’ (D-VS) and ‘responding to vital signs’ (R-VS). Perceptions of clinical utility and acceptability of DETECT e-PEWS were derived from thematic analysis of transcripts. Results Fourteen HPs (12 nurses, 2 doctors) participated; seven in D-VS and seven in the R-VS group. Three main themes were identified: complying with DETECT e-PEWS, circumventing DETECT e-PEWS, and disregarding DETECT e-PEWS. Overall clinical utility and acceptability were deemed good for HPs in the D-VS group but there was diversity in perception in the R-VS group (nurses found it more acceptable than doctors). Compliance was better in the D-VS group where use of DETECT e-PEWS was mandated and used more consistently. Some health professionals circumvented DETECT e-PEWS and fell back into old habits. Doctors (R-VS) did not consistently engage with DETECT e-PEWS, which reduced the acceptability of the system, even in those who thought the system brought benefits. Conclusions Speed and accuracy of real-time data, automation of triggering alerts and improved situational awareness were key factors that contributed to the acceptability of DETECT e-PEWS. Mandating use of both recording and responding aspects of DETECT e-PEWS is needed to ensure full implementation.

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“…Paediatric early warning systems (PEWS) encompass a range of different interventions [ 1 ]. They are a means of tracking physiological state and alerting healthcare professionals about signs of deterioration, triggering a clinical review and/or escalation of care of children [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical utility and acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): A prospective e-survey of parents and health professionals

et al. 2022

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Background Paediatric early warning systems (PEWS) are a means of tracking physiological state and alerting healthcare professionals about signs of deterioration, triggering a clinical review and/or escalation of care of children. A proactive end-to-end deterioration solution (the DETECT surveillance system) with an embedded e-PEWS that included sepsis screening was introduced across a tertiary children’s hospital. One component of the implementation programme was a sub-study to determine an understanding of the DETECT e-PEWS in terms of its clinical utility and its acceptability. Aim This study aimed to examine how parents and health professionals view and engage with the DETECT e-PEWS apps, with a particular focus on its clinical utility and its acceptability. Method A prospective, closed (tick box or sliding scale) and open (text based) question, e-survey of parents (n = 137) and health professionals (n = 151) with experience of DETECT e-PEWS. Data were collected between February 2020 and February 2021. Results Quantitative data were analysed using descriptive and inferential statistics and qualitative data with generic thematic analysis. Overall, both clinical utility and acceptability (across seven constructs) were high across both stakeholder groups although some challenges to utility (e.g., sensitivity of triggers within specific patient populations) and acceptability (e.g., burden related to having to carry extra technology) were identified. Conclusion Despite the multifaceted nature of the intervention and the complexity of implementation across a hospital, the system demonstrated clinical utility and acceptability across two key groups of stakeholders: parents and health professionals.

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A preimplementation survey for a standardised approach to paediatric early warning systems

Cited by 6 publications

References 3 publications

Paediatric early warning systems: not a simple answer to a complex question

Paediatric early warning systems: not a simple answer to a complex question

Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study

Clinical utility and acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): A prospective e-survey of parents and health professionals

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