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[Results of applying a paediatric early warning score system as a healthcare quality improvement plan]
M J Rivero-Martín1, S Prieto-Martínez1, M García-Solano2
1Servicio de Pediatría, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España.
Insights
The paediatric early warning score (PEWS) effectively standardizes clinical assessment in children, aiding in early detection of deterioration. While PEWS showed promise, further data is needed to fully evaluate its impact on severe outcomes like PICU admissions or deaths.
Area of Science:
- Pediatric critical care medicine
- Clinical informatics
- Nursing practice
Background:
- Implementing standardized tools is crucial for early detection of clinical deterioration in pediatric patients.
- Effective communication and response protocols are essential for timely medical intervention.
Purpose of the Study:
- To integrate a paediatric early warning score (PEWS) into routine clinical practice.
- To assess PEWS's efficacy in identifying clinical deterioration in hospitalized children.
- To train nursing staff on effective communication and response to PEWS alerts.
Main Methods:
- A retrospective analysis of PEWS implementation in electronic health records for children aged 0-15 years.
- Data collected on scoring frequency, data completeness, score thresholds, medical review rates, and treatment modifications.
- Monitoring of outcomes including Paediatric Intensive Care Unit (PICU) admission and mortality.
Main Results:
- PEWS was implemented across 931 admitted patients, with 7,917 measurements recorded.
- Complete data capture was achieved in 78.8% of assessments.
- Scores exceeding the threshold (>3) were rare (1.9%), but 14% led to treatment intensification or further diagnostic tests.
- One patient with a score of 2 required PICU admission; no deaths occurred.
Conclusions:
- PEWS provides a standardized method for assessing pediatric inpatient clinical status.
- The system facilitates data capture and alerts for potential clinical deterioration.
- Further studies with additional data are required to fully evaluate PEWS's impact on preventing severe adverse events such as PICU admission or mortality.
Objectives:
The aims of this study were to introduce a paediatric early warning score (PEWS) into our daily clinical practice, as well as to evaluate its ability to detect clinical deterioration in children admitted, and to train nursing staff to communicate the information and response effectively.
Material And Methods:
An analysis was performed on the implementation of PEWS in the electronic health records of children (0-15 years) in our paediatric ward from February 2014 to September 2014. The maximum score was 6. Nursing staff reviewed scores >2, and if >3 medical and nursing staff reviewed it. Monitoring indicators: % of admissions with scoring; % of complete data capture; % of scores >3; % of scores >3 reviewed by medical staff, % of changes in treatment due to the warning system, and number of patients who needed Paediatric Intensive Care Unit (PICU) admission, or died without an increased warning score.
Results:
The data were collected from all patients (931) admitted. The scale was measured 7,917 times, with 78.8% of them with complete data capture. Very few (1.9%) showed scores >3, and 14% of them with changes in clinical management (intensifying treatment or new diagnostic tests). One patient (scored 2) required PICU admission. There were no deaths. Parents or nursing staff concern was registered in 80% of cases.
Conclusions:
PEWS are useful to provide a standardised assessment of clinical status in the inpatient setting, using a unique scale and implementing data capture. Because of the lack of severe complications requiring PICU admission and deaths, we will have to use other data to evaluate these scales.
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