Pediatric Early Warning Systems aid in triage to intermediate versus intensive care for pediatric oncology patients in resource‐limited hospitals

Agulnik, Asya; Nadkarni, Anisha; Robles, Lupe Nataly Mora; Vásquez, Dora Judith Soberanis; Mack, Ricardo; Antillón‐Klussmann, Federico; Rodríguez‐Galindo, Carlos

doi:10.1002/pbc.27076

Cited by 17 publications

(29 citation statements)

References 22 publications

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“…In 2014, as a quality improvement initiative, a multidisciplinary team implemented a modified PEWS in all non‐PICU inpatient areas at UNOP, with PEWS scores calculated as part of every set of routinely obtained vital signs in hospitalized patients (typically every 3 hours) and responses to abnormal scores guided by a PEWS response algorithm. The details regarding PEWS implementation methodology, quality monitoring, and outcomes have been described previously …”

Section: Methodsmentioning

confidence: 99%

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Cost‐benefit analysis of implementing a pediatric early warning system at a pediatric oncology hospital in a low‐middle income country

Agulnik

Antillón‐Klussmann

Vásquez³

et al. 2019

Cancer

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Background Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in low‐income and middle‐income countries (LMICs). Pediatric early warning systems (PEWS) assist with the early identification of deterioration. To the authors' knowledge, no studies to date have evaluated the cost‐benefit of PEWS in LMICs. Methods A PEWS was implemented at the National Pediatric Oncology Unit (Unidad Nacional de Oncologia Pediatrica [UNOP]), a pediatric oncology hospital in Guatemala, resulting in a reduction in unplanned pediatric intensive care unit (PICU) transfers. Variable costs of maintaining the PICU and hospital floor were calculated for the year prior to and after the implementation of PEWS using administrative data. PEWS implementation costs were tabulated. The number of PICU inpatient days averted due to reduced unplanned PICU transfers after implementation was calculated, adjusting for changes in hospital inpatient days. Savings per inpatient day from unplanned PICU transfers were calculated. All costs were adjusted for inflation. Results There were 457 fewer PICU inpatient days due to unplanned transfers noted the year after implementation of PEWS, adjusting for changes in hospital volume. The variable costs of an unplanned PICU transfer versus a bed on the hospital floor was $806 per day. The total cost of implementing PEWS at UNOP was $13,644 ($7 per admission). Through reductions in variable PICU costs, UNOP saved a net $173 per admission ($354,514 annual net savings) after implementation of PEWS. The cost savings were sustained in a series of more conservative 1‐way sensitivity analyses. Conclusions Implementation of PEWS at UNOP resulted in an incremental savings due to a reduction in the number of unplanned PICU transfers. The results of the current study demonstrate that hospital investment in PEWS can improve the quality of pediatric cancer care, optimize PICU use, and reduce costs.

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Section: Methodsmentioning

confidence: 99%

“…The details regarding PEWS implementation methodology, quality monitoring, and outcomes have been described previously. 20,22 Cancer November 15, 2019…”

Section: Methodsmentioning

confidence: 99%

Cost‐benefit analysis of implementing a pediatric early warning system at a pediatric oncology hospital in a low‐middle income country

Agulnik

Antillón‐Klussmann

Vásquez³

et al. 2019

Cancer

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“…These scoring systems include various vital signs and other clinical characteristics for quick classification of decompensation risk. They have been shown to accurately predict the need for intensive care unit level of care and are better predictors of clinical deterioration than physician opinion alone (26)(27)(28)(29)(30)(31)(32)(33)(34). Implementation studies have shown that clinical outcomes are improved in some settings because the early recognition of patient decline allows for earlier intervention (34).…”

Section: Research/professional Developmentmentioning

confidence: 99%

Evolution of a Bidirectional Pediatric Critical Care Educational Partnership in a Resource-Limited Setting

et al. 2021

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Introduction: Children in resource-limited settings are disproportionately affected by common childhood illnesses, resulting in high rates of mortality. A major barrier to improving child health in such regions is limited pediatric-specific training, particularly in the care of children with critical illness. While global health rotations for trainees from North America and Europe have become commonplace, residency and fellowship programs struggle to ensure that these rotations are mutually beneficial and do not place an undue burden on host countries. We created a bidirectional, multimodal educational program between trainees in Manila, Philippines, and Baltimore, Maryland, United States, to improve the longitudinal educational experience for all participants.Program Components: Based on stakeholder input and a needs assessment, we established a global health training program in which pediatricians from the Philippines traveled to the United States for observerships, and pediatric residents from a tertiary care center in Baltimore traveled to Manila. Additionally, we created and implemented a contextualized simulation-based shock curriculum for pediatric trainees in Manila that can be disseminated locally. This bidirectional program was adapted to include telemedicine and regularly scheduled “virtual rounds” and educational case conferences during the COVID-19 pandemic. Providers from the two institutions have collaborated on educational and clinical research projects, offering opportunities for resource sharing, bidirectional professional development, and institutional improvements.Conclusion: Although creating a mutually beneficial global health partnership requires careful planning and investment over time, establishment of a successful bidirectional educational and professional development program in a limited-resource setting is feasible and benefits learners in both countries.

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“…Implementation of modified PEWS decreased the number of unplanned PICU transfers and improved PICU utilisation in Guatemala and assisted in identifying children with cancer who would benefit from more intensive monitoring in the intermediate care environment 30. A prospective nested case-controlled study in Malawi indicated that a locally developed PEWS could identify children at high risk of death 31.…”

Section: Where Are They Used and How Do They Perform?mentioning

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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Pediatric Early Warning Systems aid in triage to intermediate versus intensive care for pediatric oncology patients in resource‐limited hospitals

Cited by 17 publications

References 22 publications

Cost‐benefit analysis of implementing a pediatric early warning system at a pediatric oncology hospital in a low‐middle income country

Cost‐benefit analysis of implementing a pediatric early warning system at a pediatric oncology hospital in a low‐middle income country

Evolution of a Bidirectional Pediatric Critical Care Educational Partnership in a Resource-Limited Setting

Early warning scores in paediatrics: an overview

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