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Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic
Veronica Lambert1, Anne Matthews1, Rachel MacDonell2
1School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland.
Insights
Paediatric Early Warning Systems (PEWS) are widely used in hospitals, showing positive trends in improving care for deteriorating children. However, more research is needed to determine the most effective PEWS and understand their complex nature.
Area of Science:
- Pediatric healthcare
- Clinical informatics
- Patient safety systems
Background:
- Paediatric Early Warning Systems (PEWS) are crucial for detecting clinical deterioration in children.
- Existing systems are widely implemented in acute paediatric settings globally.
- Limited robust evidence exists on the comparative effectiveness of different PEWS.
Purpose of the Study:
- To systematically review evidence on PEWS in acute paediatric healthcare.
- To assess the detection and response to clinical deterioration in children using PEWS.
- To identify effective PEWS strategies in paediatric hospital settings.
Main Methods:
- Systematic literature search of major electronic databases (PubMed, MEDLINE, CINAHL, EMBASE, Cochrane) up to August 2016.
- Inclusion of studies on PEWS, rapid response systems, and their impact on paediatric clinical deterioration.
- Narrative synthesis of findings from 90 eligible papers.
Main Results:
- PEWS are extensively used internationally in paediatric inpatient settings.
- Limited robust evidence exists on the most effective PEWS.
- Studies indicate positive trends in clinical and process outcomes for deteriorating children.
- Improved teamwork, communication, and confidence in managing child deterioration were noted.
Conclusions:
- PEWS are complex, multifaceted interventions within healthcare systems.
- Future research should investigate PEWS as sociotechnical systems within safety cultures.
- PEWS should be integrated into broader safety frameworks with strong governance and continuous improvement.
Objective:
To systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children.
Method:
The electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments). 2 review authors independently completed the screening and selection process, the quality appraisal of the retrieved evidence and data extraction; with a third reviewer resolving any discrepancies, as required. Results were narratively synthesised.
Results:
From a total screening of 2742 papers, 90 papers, of varied designs, were identified as eligible for inclusion in the review. Findings revealed that PEWS are extensively used internationally in paediatric inpatient hospital settings. However, robust empirical evidence on which PEWS is most effective was limited. The studies examined did however highlight some evidence of positive directional trends in improving clinical and process-based outcomes for clinically deteriorating children. Favourable outcomes were also identified for enhanced multidisciplinary team work, communication and confidence in recognising, reporting and making decisions about child clinical deterioration.
Conclusions:
Despite many studies reporting on the complexity and multifaceted nature of PEWS, no evidence was sourced which examined PEWS as a complex healthcare intervention. Future research needs to investigate PEWS as a complex multifaceted sociotechnical system that is embedded in a wider safety culture influenced by many organisational and human factors. PEWS should be embraced as a part of a larger multifaceted safety framework that will develop and grow over time with strong governance and leadership, targeted training, ongoing support and continuous improvement.
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