Challenges and Opportunities for Implementing Pediatric Early Warning Systems in Low- and Middle-Income Countries—Using Resources Wisely

Abstract

The capacity for intensive care and continuous monitoring in low and middle-income countries is often outstripped by demand due to the high burden of critical illness. 1 Early warning scores developed in resource-rich settings are being adopted in resource-limited settings to identify patients whose conditions are deteriorating and require escalation of care. Pediatric early warning systems (PEWS) are designed to trigger an algorithm-based response depending on a risk score derived from clinical symptoms and signs. 2 Agulnik et al 3 report on the findings of a qualitative study exploring barriers and facilitators to PEWS implementation in 5 resource-limited pediatric oncology centers in Latin America. Using the Consolidated Framework for Implementation Research, the authors identified that the factors crucial to PEWS implementation cut across all the 5 domains and barriers to implementation in one setting or at one stage can be enablers in another setting or transform over the implementation process. 4 Enablers of PEWS implementation included characteristics of the intervention, support from an established collaborative network, simplicity of the intervention, the perceived strength of evidence, and the availability of funding to support implementation. Examples of barriers identified in the study Open Access: This is an open access article distributed under the terms of the CC-BY License.

Connecting Clinical Capacity and Intervention Sustainability in Resource-Variable Pediatric Oncology Centers in Latin America

“…While these and other studies demonstrate the effectiveness of PEWS to improve childhood cancer treatment outcomes, this evidence-based intervention is underutilized in low-resource settings, partly due to implementation challenges ( Agulnik et al, 2022a , b , c ; Nyandat et al, 2022 ). To address these barriers, St. Jude Children’s Research Hospital (St. Jude) partnered with regional stakeholders in Latin America to develop Proyecto EVAT, a quality improvement collaborative to support implementation of PEWS ( Agulnik et al, 2022a , b , c ).…”