Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance System Compared With Traditional Paper-Based Documentation

Sefton, Gerri; Lane, Steven; Killen, Roger; Black, Sue; Lyon, Max; Ampah, Pearl; Sproule, Cathryn; Loren-Gosling, Dominic; Richards, Caitlin; Spinty, J; Holloway, Colette; Davies, Coral; Wilson, April; Chean, Chung Shen; Carter, Bernie; Carrol, Enitan D.

doi:10.1097/cin.0000000000000305

Cited by 35 publications

(36 citation statements)

References 43 publications

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“…Paediatric early warning scores (PEWS) provide an adjunct to support staff in recognising deterioration in hospitalised children 2–4. Despite weak evidence2 5 6 they are widely used,7 which is driven, in part, by national recommendations and governance requirements 1 8 9…”

Section: Introductionmentioning

confidence: 99%

Missed opportunities: incomplete and inaccurate recording of paediatric early warning scores

et al. 2019

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BackgroundPaediatric early warning scores (PEWS) are widely used as an adjunct to support staff in recognising deterioration in hospitalised children. Relatively little is known about how staff use these systems.ObjectiveTo examine the completeness and accuracy of PEWS recording in hospitalised children in a tertiary specialist children’s hospital.DesignThis is a secondary analysis of retrospective, case-controlled study data. Case patients suffering from a critical deterioration event were matched with controls present on the same ward at the same time and matched for age. Data were extracted from the PEWS chart for the 48 hours before the critical deterioration event for case patients and the corresponding 48 hours period for the control. Observation sets were assessed for completeness and accuracy of PEWS scoring.ResultsIn total 297 case events in 224 patients were available for analysis. Overall 13 816 observations sets were performed, 8543 on cases and 5273 on controls. Only 4958 (35.9%) of observation sets contained a complete set of vital sign parameters and a concurrent PEWS. Errors were more prevalent in the observation sets of case patients versus controls (19.5% vs 14.1%). More errors resulted in the PEWS value being underscored rather than overscored for all observation sets (p<0.0001). 9.1% of inaccuracies for case patients were clinically significant, as the accurately calculated PEWS would have prompted a different escalation from the documented value.ConclusionFailure to record complete and accurate PEWS may jeopardise recognition of children who are deteriorating. Technology may offer an effective solution.

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Section: Introductionmentioning

confidence: 99%

Missed opportunities: incomplete and inaccurate recording of paediatric early warning scores

et al. 2019

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“…Routine clinical observations were sometimes performed inaccurately and in a similar range to other studies. [33][34][35][36][37][38][39][40] With purposeful scenario-based training, the clinical observation skills improved from 66…”

Section: Discussionmentioning

confidence: 99%

“…[34][35][36][37][52][53][54] The score was accurate in 92% of patients (97% of the 95% that had a score documented), which is considerably higher than the 54 to 84% summation error in paediatric and adult studies. [34,46,51,52] Incorrect summation and plotting of parameters could contribute to inaccurate PEW scores, misrepresent the graphic trend and lead to omitted escalation. It is unclear what the acceptable or optimal accuracy threshold is for the score as part of a larger system of overlapping safety.…”

Section: Discussionmentioning

confidence: 99%

Quality Improvement Implementation and Maintenance of a Paediatric Early Warning System

Duncan¹,

Oliver²,

Emms³

et al. 2020

Preprint

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Background: Paediatric Early Warning (PEW) systems have led to earlier identification and escalation of treatment with subsequent admission to Paediatric Intensive Care (PIC) in deteriorating children. The impact on reductions in cardiac arrest and mortality vary between the heterogeneous studies, showing both unchanged and reduced cardiac arrest, morbidity and mortality. Identifying and managing critical illness on wards is a complex and dynamic process involving technology, human interaction, cultural context and environment. We introduced a PEW system to reduce potentially avoidable cardiac arrest and death.Methods: We report an Implementation Science Quality Improvement (QI) natural experiment using the Medical Research Councils (MRC) Guidelines for Developing and Evaluating Complex Interventions, Action Research, Action Research Theory and methods. The aim of this program was to identify learning, refinement and improvement opportunities to reduce poor outcomes. The interventions were 1) developing an observation and monitoring policy to standardise practice and provide a template for optimal care, 2) standardized charting with an embedded PEW score, 3) clinical skills training, 4) clinical process audit and feedback and 5) outcome surveillance.The process measures were 1) timeliness and impact for unplanned Paediatric Intensive Care (PIC) admissions, 2) clinical assessment skills and 3) chart completion compliance. The outcome measures included 4) total and predictable cardiac arrests and 5) hospital mortality. Data collection started in 2004, the PEW system was implemented in 2008, and the outcomes were reported through 2018.Results: In our specialist children’s hospital, we completed six improvement cycles over 10 years. 1) Timely PIC admissions improved after implementation (39% to 92%). Patients with unplanned PIC admissions had significantly lower severity of illness and mortality but a longer length of stay. 2) Routine clinical observation accuracy improved (66 to 82%) following multimodal training. 3) Chart completion compliance improved (87 to 99%). In 2018, 2% of observations had missing or inaccurate parameters with a consequent inaccurate total PEW score. 4) The total cardiac arrest rate was significantly reduced (0.36 to 0.16 per 1000 admissions). The small numbers of predictable cardiac arrests showed a decreasing trend. 5) Hospital mortality was significantly reduced (3.46 to 2.24 per 1000 admissions). Outcomes improved approximately 18 months after implementation and have not changed significantly since 2010 despite increasing critical care resources in and out of PIC. The impact of the PEW system on these outcomes is possible but not conclusive.Conclusion: Implementation of the PEW system as a complex intervention using QI methods is associated with improved clinical skill accuracy, chart compliance and detection of deterioration associated with more timely unplanned PIC admissions. These improvements were associated with a significant reduction in cardiac arrest and mortality.

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“…This may improve accuracy and efficiency when compared with paper-based systems and offers the potential to automate the escalation of children with elevated scores 37. Using PEWS within an EHR also offers the opportunity to collect large sets of data to further develop and validate the evidence base for PEWS 38…”

Section: The Futurementioning

confidence: 99%

Early warning scores in paediatrics: an overview

Chapman

Maconochie

2018

Arch Dis Child

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Paediatric Early Warning Scores (PEWS)are used in hospitalised patients to detect physiological deterioration and is being used increasingly throughout healthcare systems with a limited evidence based. There are two versions in general use that can lead to a clinical response, either by triggering an action or by reaching a ‘threshold’ when graduated responses may occur depending on the value of the score. Most evidence has come from research based on paediatric inpatients in specialist children’s hospitals, although the range of research is expanding, taking into account other clinical areas such as paediatric intensive care unit, emergency department and the prehospital setting. Currrently, it is uncertain whether a unified system does deliver benefits in terms of outcomes or financial savings, but it may inform and improve patient communication. PEWS may be an additional tool in context of a patient’s specific condition, and future work will include its validation for different conditions, different clinical settings, patient populations and organisational structure. The incorporation of PEWS within the electronic health records may form a keystone of the safe system framework and allow the development of consistent PEWS system to standardise practice.

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Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance System Compared With Traditional Paper-Based Documentation

Cited by 35 publications

References 43 publications

Missed opportunities: incomplete and inaccurate recording of paediatric early warning scores

Missed opportunities: incomplete and inaccurate recording of paediatric early warning scores

Quality Improvement Implementation and Maintenance of a Paediatric Early Warning System

Early warning scores in paediatrics: an overview

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