Adherence to the bedside paediatric early warning system (BedsidePEWS) in a pediatric tertiary care hospital

Abstract

Background The aim of this study is to describe the adherence to the Bedside Pediatric Early Warning System (BedsidePEWS) escalation protocol in children admitted to hospital wards in a large tertiary care children’s hospital in Italy. Methods This is a retrospective observational chart review. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded. Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P < 0.05 considered as significant). Results A total of 522 Vital Signs (VS) and score calculations [BedsidePEWS documentation events, (DE)] on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of BedsidePEWS DE occurred < 3 times per day in 33 % of the observations. Adherence to the BedsidePEWS documentation frequency according to the hospital protocol was observed in 54 % of all patients; in children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47 % vs. 69 %, P = 0.006). The BedsidePEWS score was correctly calculated and documented in 84 % of the BedsidePEWS DE. Patients in a 0–2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50 % of the patients in the 5–6 score range were reviewed within 4 h and 42 % of the patients with a score ≥ 7 within 2 h. Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience

“…This finding is mainly attributed to the successful integration of the early identification of potential sepsis cases and prompt management. As observed in the literature, among all the interventions aimed at improving survival in patients with sepsis, fast recognition and the timely initiation of therapy, including antimicrobial administration, are the most important components 1 , 2 , 9 – 13 . Different approaches have been investigated to address the timely implementation of the recommended management.…”

“…Given that the diagnosis of potential sepsis cases is the cornerstone of therapeutic practice, a more structured and relatively objective approach is required to minimize human-related factors that could result in potential sepsis cases being missed. Such efforts led to the proposal of the PEWS system, which is widely accepted and has been validated in different settings with the potential benefit of identifying sepsis cases earlier and thus improving outcomes 1 , 9 , 20 . However, compliance with PEWS and integrated bundles requires reliable performance, high compliance, and regular audits, which could be challenging and resource demanding due to human factors 9 , 21 , 22 .…”

“…Such efforts led to the proposal of the PEWS system, which is widely accepted and has been validated in different settings with the potential benefit of identifying sepsis cases earlier and thus improving outcomes 1 , 9 , 20 . However, compliance with PEWS and integrated bundles requires reliable performance, high compliance, and regular audits, which could be challenging and resource demanding due to human factors 9 , 21 , 22 . The need for automated, effective, and timely screening tools for sepsis screening triggered further investment and investigations aimed at integrating health informatics and data analysis models 23 , 24 .…”

Parents’ experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic pediatric early warning system (the DETECT study): A qualitative interview study

“…Pediatric early warning systems (PEWS) ( 4 , 11 , 12 ) or PEW scores ( 13 – 15 ) are a means by which health professionals (HPs) can be alerted to signs of deterioration, trigger a review and escalate care as needed. PEW scoring allows HPs to record a child’s vital signs and other key data including parent concern ( 16 , 17 ).…”

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

“…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]. PEWS are reported to be used extensively internationally [2,3] and across different health care settings such as emergency departments [4][5][6], oncology and haematology [7][8][9], and more rarely, hospital wide [10,11] or nationally [12]. PEWS are used in paediatric in-patient hospital settings [2] in resource-rich [10] and resource-limited countries [7,13].…”