Impact of PEWS on Perceived Quality of Care During Deterioration in Children With Cancer Hospitalized in Different Resource-Settings

Garza, Marcela; Graetz, Dylan E.; Kaye, Erica C.; Ferrara, Gia; Rodriguez, Mario; Vásquez, Dora Judith Soberanis; Aceituno, Alejandra Méndez; Antillón‐Klussmann, Federico; Gattuso, Jami S.; Mandrell, Belinda N.; Baker, Justin N.; Rodríguez‐Galindo, Carlos; Agulnik, Asya

doi:10.3389/fonc.2021.660051

Cited by 18 publications

(21 citation statements)

References 20 publications

(27 reference statements)

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“…Our study demonstrates multiple benefits of PEWS implementation for patients, clinicians, healthcare teams, and institutions and the ways in which these benefits modulate and reinforce one another. Similar to prior studies, we found that staff perceived PEWS to reduce adverse events (8), improve quality-of-care (9), increase staff knowledge, confidence, and empowerment (10), improve interprofessional and interdisciplinary communication (11), and reduce hospital costs (13). Our study, however, additionally demonstrates that improvements in patient outcomes increase staff motivation and job satisfaction, and better interpersonal relationships foster an improved work environment leading to changes in hospital culture including increased emphasis on patient-centered care, patient safety, and quality improvement.…”

Section: Discussionsupporting

confidence: 87%

“…The impacts of PEWS have been demonstrated across multiple levels of hospital care. PEWS decrease clinical deterioration events and pediatric intensive care unit (PICU) utilization ( 8 ), and improve the perceived quality of care ( 9 ). PEWS have also been shown to foster nursing empowerment and increase confidence in recognizing and managing clinical deterioration ( 10 ), improve interdisciplinary communication and relationships ( 11 , 12 ), and lead to cost savings ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

et al. 2022

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BackgroundPediatric Early Warning Systems (PEWS) reduce clinical deterioration, improve interdisciplinary communication, and provide cost savings; however, little is known about how these impacts are achieved or related. This study evaluates the multi-level impacts of PEWS in resource-limited pediatric oncology centers.MethodsWe conducted 71 semi-structured interviews including physicians (45%), nurses (45%), and administrators (10%) from 5 resource-limited pediatric oncology centers in 4 Latin American countries. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed using a priori and inductively derived codes. Transcripts were independently coded by 2 coders, achieving a kappa of 0.8-0.9. Thematic content analysis explored perceived impacts of PEWS at the level of the patient, clinician, healthcare team, and institution.ResultsPEWS improved the quality of attention for patients, reducing morbidity and mortality. Clinicians felt more knowledgeable, confident, and empowered providing patient care, resulting in greater job satisfaction. PEWS affected team dynamics by improving interdisciplinary (ward and intensive care unit) and interprofessional (physicians and nurses) relationships and communication. This ultimately led to institutional culture change with emphasis on patient safety, collaboration with other centers, and receipt of institutional awards. Together, these impacts led to hospital-wide support of ongoing PEWS use.ConclusionsIn resource-limited hospitals, PEWS use results in multi-level positive impacts on patients, clinicians, teams, and institutions, creating a feedback loop that further supports ongoing PEWS use. These findings can guide advocacy for PEWS to various stakeholders, improve PEWS effectiveness, and inform assessment of other interventions to improve childhood cancer outcomes.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

et al. 2022

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“…8,9 Implementation of PEWS improves patient outcomes, reduces the cost of care, and optimizes interdisciplinary communication in resource-limited hospitals. [10][11][12][13][14][15][16] Despite evidence of their benefits, PEWS are not widely used in hospitals with resource limitations. 5 Although reasons for this practice gap are multidimensional, resource-limited hospitals likely experience specific barriers to implementation of evidence-based practices, and challenges implementing PEWS may discourage their use in these settings.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings

et al. 2022

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IMPORTANCE Pediatric early warning systems (PEWS) aid with early identification of clinical deterioration and improve outcomes in children with cancer hospitalized in resource-limited settings; however, there may be barriers to implementation. OBJECTIVE To evaluate stakeholder-reported barriers and enablers to PEWS implementation in resource-limited hospitals. DESIGN, SETTING, AND PARTICIPANTSIn this qualitative study, semistructured stakeholder interviews were conducted at 5 resource-limited pediatric oncology centers in 4 countries in Latin America. Hospitals participating in a multicenter collaborative to implement PEWS were purposefully sampled based on time required for implementation (fast vs slow), and stakeholders interviewed included physicians, nurses, and administrators, involved in PEWS implementation. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR).Interviews were conducted virtually in Spanish, audiorecorded, and professionally transcribed and translated into English. A codebook was developed a priori using the CFIR and supplemented with codes inductively derived from transcript review. Two coders independently analyzed all transcripts, achieving a κ of 0.8 to 0.9. The study was conducted from June 1 to August 31, 2020. MAIN OUTCOMES AND MEASURES Thematic analysis was conducted based on CFIR domains(inner setting, characteristics of individuals, outer setting, intervention characteristics, and implementation process) to identify barriers and enablers to PEWS implementation. RESULTSSeventy-one staff involved in PEWS implementation were interviewed, including 32 physicians (45%), 32 nurses (45%), and 7 administrators (10%). Of these, 50 were women (70%).Components of the 5 CFIR domains were mentioned by participants as barriers and enablers to PEWS implementation at both fast-and slow-implementing centers. Participants emphasized barriers at the level of the clinical staff, hospital, external factors, and PEWS intervention. These barriers included staff resistance to change, inadequate resources, components of health systems, and the perceived origin and complexity of PEWS. At all centers, most barriers were successfully converted to enablers during the implementation process through targeted strategies, such as early stakeholder engagement and adaptation, including adapting PEWS to better fit the local context and changing the hospital setting to support ongoing use of PEWS. CONCLUSIONS AND RELEVANCETo date, this is the first multicenter, multinational study describing barriers and enablers to PEWS implementation in resource-limited settings. Findings suggest that many barriers are not immutable and can be converted to enablers during the (continued) Key Points Question What barriers and enablers to pediatric early warning systems (PEWS) implementation in resource-limited hospitals are reported by health care professionals? Findings In this qualitative study including 5 resource-limited pediatric oncology centers in 4 countries in Latin America, ma...

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

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

Alturki

Al‐Eyadhy

Alfayez

et al. 2022

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This study aimed to assess the potential impact of implementing an electronic alert system (EAS) for systemic inflammatory syndrome (SIRS) and sepsis in pediatric patients mortality. This retrospective study had a pre and post design. We enrolled patients aged ≤ 14 years who were diagnosed with sepsis/severe sepsis upon admission to the pediatric intensive care unit (PICU) of our tertiary hospital from January 2014 to December 2018. We implemented an EAS for the patients with SIRS/sepsis. The patients who met the inclusion criteria pre-EAS implementation comprised the control group, and the group post-EAS implementation was the experimental group. Mortality was the primary outcome, while length of stay (LOS) and mechanical ventilation in the first hour were the secondary outcomes. Of the 308 enrolled patients, 147 were in the pre-EAS group and 161 in the post-EAS group. In terms of mortality, 44 patients in the pre-EAS group and 28 in the post-EAS group died (p 0.011). The average LOS in the PICU was 7.9 days for the pre-EAS group and 6.8 days for the post-EAS group (p 0.442). Considering the EAS initiation time as the “zero time”, early recognition of SIRS and sepsis via the EAS led to faster treatment interventions in post-EAS group, which included fluid boluses with median (25th, 75th percentile) time of 107 (37, 218) min vs. 30 (11,112) min, p < 0.001) and time to initiate antimicrobial therapy median (25th, 75th percentile) of 170.5 (66,320) min vs. 131 (53,279) min, p 0.042). The difference in mechanical ventilation in the first hour of admission was not significant between the groups (25.17% vs. 24.22%, p 0.895). The implementation of the EAS resulted in a statistically significant reduction in the mortality rate among the patients admitted to the PICU in our study. An EAS can play an important role in saving lives and subsequent reduction in healthcare costs. Further enhancement of systematic screening is therefore highly recommended to improve the prognosis of pediatric SIRS and sepsis. The implementation of the EAS, warrants further validation in multicenter or national studies.

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Impact of PEWS on Perceived Quality of Care During Deterioration in Children With Cancer Hospitalized in Different Resource-Settings

Cited by 18 publications

References 20 publications

Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings

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

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