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What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit?
G Sefton1, C McGrath1, L Tume1
1PICU, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom.
Insights
Paediatric Early Warning Systems (PEWs) improved patient outcomes in a tertiary children's hospital. PEWs reduced the Paediatric Index of Mortality (PIM2) and length of PICU stay, enhancing service delivery.
Area of Science:
- Pediatric critical care medicine
- Healthcare quality improvement
- Clinical informatics
Background:
- The core principle of Paediatric Early Warning systems (PEWs) is that early identification of deteriorating pediatric inpatients can lead to improved clinical outcomes.
- Implementing PEWs aims to enhance patient care by enabling timely interventions.
Purpose of the Study:
- To evaluate the impact of introducing PEWs at a tertiary children's hospital on emergency admissions to the Pediatric Intensive Care Unit (PICU).
- To assess the effect of PEWs on overall service delivery within the PICU.
- To compare outcomes of 'in-house' PICU admissions with 'external' admissions from District General Hospitals lacking PEWs.
Main Methods:
- A before-and-after observational study design was employed.
- Data were collected during two periods: August 2005-July 2006 (pre-PEWs implementation) and August 2006-July 2007 (post-PEWs implementation).
- The study was conducted at a tertiary children's hospital.
Main Results:
- The median Paediatric Index of Mortality (PIM2) significantly decreased post-PEWs implementation (0.44 vs. 0.60, p<0.001).
- Fewer PICU admissions required invasive ventilation (62.7% vs. 75.2%, p=0.015) and the median duration of ventilation decreased from four to two days.
- The median length of PICU stay was reduced (five to three days, p=0.002).
- A 39% reduction in emergency admission bed days was observed, leading to fewer cancellations of elective surgeries and reduced refusal of external PICU referrals.
Conclusions:
- The introduction of PEWs at a tertiary children's hospital led to a reduction in PIM2 scores.
- Patients admitted to the PICU post-PEWs implementation required fewer interventions and had a shorter length of stay.
- PICU service delivery demonstrated significant improvement following the implementation of PEWs.
Unlabelled:
The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes.
Objective:
To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs).
Method:
A before-and-after observational study August 2005-July 2006 (pre), August 2006-July 2007 (post) implementation of PEWs at the tertiary children's hospital.
Results:
The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (p<0.001). Fewer admissions required invasive ventilation 62.7% vs 75.2% (p=0.015) for a shorter median duration; four to two days. The median length of PICU stay reduced; five to three days (p=0.002). There was a non-significant reduction in mortality (p=0.47). There was no comparable improvement in outcome seen in external emergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals.
Conclusions:
Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved.
