Qualitative Study of Pediatric Early Warning Systems’ Impact on Interdisciplinary Communication in Two Pediatric Oncology Hospitals With Varying Resources

Graetz, Dylan E.; Kaye, Erica C.; Garza, Marcela; 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; Mack, Jennifer W.; Agulnik, Asya

doi:10.1200/go.20.00163

Cited by 29 publications

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“…Multidisciplinary pediatric oncology clinicians were interviewed at Unidad Nacional de Oncologıá Pediatrica (UNOP) and St. Jude Children's Research Hospital (SJCRH), two free-standing pediatric oncology hospitals, between October and December 2018. Detailed methods of this study including setting, population, and data collection have been previously described (8). Briefly, UNOP is located in Guatemala City, Guatemala, an upper middle-income country with a gross national income (GNI) of US $4,410 per capita.…”

Section: Methodsmentioning

confidence: 99%

“…While PEWS have been primarily implemented and studied in high-resource settings, pediatric cancer is a global health issue, with approximately 90% of pediatric cancer diagnoses occurring in countries with limited resources (7). Previous studies have shown that PEWS implementation in a resource-limited pediatric oncology setting reduces clinical deterioration events and hospital costs, while improving interdisciplinary communication (5,8,9).…”

Section: Introductionmentioning

confidence: 99%

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Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

et al. 2021

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BackgroundPediatric oncology patients have a high rate of clinical deterioration frequently requiring critical care. Patient deterioration events are distressing for clinicians, but little is known about how Pediatric Early Warning Systems (PEWS) impact clinicians’ emotional responses to deterioration events.MethodsSemi-structured interviews were conducted with 83 nurses, pediatricians, oncologists, and intensive care clinicians who had recently participated in a patient deterioration event at two pediatric oncology hospitals of different resource-levels: St. Jude Children’s Research Hospital (N = 42 participants) in Memphis, Tennessee or Unidad Nacional de Oncología Pediátrica (N = 41 participants) in Guatemala City, Guatemala. Interviews were conducted in the participants’ native language (English or Spanish), transcribed, and translated into English. Each transcript was coded by two researchers and analyzed for thematic content.ResultsEmotions around patient deterioration including concern, fear, and frustration were reported across all disciplines at both hospitals. Concern was often triggered by an elevated PEWS score and usually resulted in increased attention, which reassured bedside clinicians that patients were receiving necessary interventions. However, persistently elevated PEWS scores, particularly at St. Jude Children’s Research Hospital, occasionally resulted in a false sense of relief, diminishing clinician attention and negatively impacting patient care. Nurses at both institutions described how PEWS amplified their voices, engendering confidence and empowerment, two of the only positive emotions described in the study.ConclusionClinicians experienced a range of emotions while caring for high-risk patients in the setting of clinical deterioration. These emotions have the potential to contribute to compassion fatigue and burnout, or to resilience. Acknowledgment and further investigation of the complex interplay between PEWS and clinician emotions are necessary to maximize the impact of PEWS on patient safety while simultaneously supporting staff wellbeing.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

et al. 2021

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“…Interviews were conducted during the fall of 2018 at two hospitals dedicated to the care of children with cancer: Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala and St. Jude Children’s Research Hospital (St. Jude) in Memphis, USA. Study design and methods have been previously described ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

“…Transcribed interviews underwent qualitative content analysis using codes derived inductively from transcript review ( 13 ). Code definitions are described in Supplemental Table 1 ( 10 ). Each interview transcript was independently coded by two researchers (MG, DG, GF).…”

Section: Methodsmentioning

confidence: 99%

“…PEWS are bedside tools composed of a scoring instrument and an associated intervention algorithm used to proactively identify clinical deterioration and facilitate early transfer to the ICU ( 4 ). PEWS have been validated for use with pediatric oncology patients, including in resource limited settings ( 5 – 7 ), and have been shown to reduce frequency of clinical deterioration in hospitalized pediatric cancer patients ( 8 ) and improve interdisciplinary communication ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

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

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BackgroundChildren with cancer are at high risk for clinical deterioration and subsequent mortality. Pediatric Early Warning Systems (PEWS) have proven to reduce the frequency of clinical deterioration in hospitalized patients. This qualitative study evaluates provider perspectives on the impact of PEWS on quality of care during deterioration events in a high-resource and a resource-limited setting.MethodsWe conducted semi-structured interviews with 83 healthcare staff (nurses, pediatricians, oncology fellows, and intensivists) involved in recent deterioration events at two pediatric oncology hospitals of different resource levels: St. Jude Children’s Research Hospital (SJCRH; n = 42) and Unidad Nacional de Oncología Pediátrica (UNOP; n = 41). Interviews were conducted in the participant’s native language (English or Spanish), translated into English, and transcribed. Transcripts were coded and analyzed inductively.ResultsProviders discussed both positive and negative perspectives of clinical deterioration events. Content analysis revealed “teamwork,” “experience with deterioration,” “early awareness,” and “effective communication” as themes associated with positive perception of events, which contributed to patient safety. Negative themes included “lack of communication,” “inexperience with deterioration,” “challenges with technology”, “limited material resources,” “false positive score,” and “objective tool.” Participants representing all disciplines across both institutions shared similar positive opinions. Negative opinions, however, differed between the two institutions, with providers at UNOP highlighting limited resources while those at SJCRH expressing concerns about technology misuse.ConclusionProviders that care for children with cancer find PEWS valuable to improve the quality of hospital care, regardless of hospital resource-level. Identified challenges, including inadequate critical care resources and challenges with technology, differ by hospital resource-level. These findings build on growing data demonstrating the positive impact of PEWS on quality of care and encourage wide dissemination of PEWS in clinical practice.

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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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Qualitative Study of Pediatric Early Warning Systems’ Impact on Interdisciplinary Communication in Two Pediatric Oncology Hospitals With Varying Resources

Cited by 29 publications

References 28 publications

Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

Clinician Emotions Surrounding Pediatric Oncology Patient Deterioration

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

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

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