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Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance
Gerri Sefton1, Steven Lane, Roger Killen
1Author Affiliations: Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust (Ms Sefton); and Institute of Translational Medicine (Dr Lane), and The Learning Clinic Ltd, 1 Sussex Place, London (Mr Killen); Faculty of Medicine, University of Liverpool, Liverpool (Mr Black, Mr Lyon, Ms Ampah, Ms Sproule, Mr Loren-Gosling, Ms Richards, Mr Spinty, Ms Holloway, Ms Davies, Ms Wilson, and Mr Chean); University of Central Lancashire, College of Health and Wellbeing, Preston, and Children's Nursing Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool (Ms Carter); and Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom (Dr Carrol).
Insights
Electronic systems significantly improve the accuracy and speed of pediatric early warning score (PEWS) documentation in hospitals. This reduces critical errors, enhancing patient safety for hospitalized children.
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Clinical process improvement
Background:
- Pediatric Early Warning Scores (PEWS) are crucial for detecting deterioration in hospitalized children.
- Errors in PEWS documentation (recording, calculation) can compromise patient safety.
- Traditional paper-based charting is susceptible to process errors.
Purpose of the Study:
- To compare the accuracy and efficiency of electronic documentation (VitalPAC Pediatric) versus paper charts for PEWS.
- To assess user acceptability of both documentation methods.
Main Methods:
- A controlled study using clinical vignettes to evaluate documentation accuracy and time.
- Comparison of an electronic physiological surveillance system (VitalPAC Pediatric) with paper charts.
- A Web-based survey to explore user perceptions and acceptability.
Main Results:
- The electronic system significantly improved vital sign recording accuracy (98.5% vs. 85.6%, P < .02).
- PEWS calculation accuracy was higher with the electronic system (94.6% vs. 55.7%, P < .02).
- Documentation time was reduced using the electronic system (68 seconds vs. 98 seconds, P < .002).
Conclusions:
- Electronic physiological surveillance systems enhance the reliability of PEWS by minimizing human error.
- The VitalPAC Pediatric system offers safety benefits and improves data visibility for clinical teams.
- Adoption of electronic systems in pediatric care can lead to safer and more efficient patient monitoring.
Abstract:
Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined "norm." Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team.
