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Implementing paediatric early warning scores systems in the Netherlands: future implications.

J F de Groot1, N Damen2, E de Loos3

  • 1NIVEL Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 CR, Utrecht, the Netherlands. j.degroot@nivel.nl.

BMC Pediatrics
|April 8, 2018
PubMed
Summary

Paediatric Early Warning Scores (PEWS) implementation improved patient record use, but staff doubts about effectiveness and the lack of national guidelines hinder full adoption. A national PEWS system is recommended for better patient safety.

Keywords:
ImplementationPEWSPaediatric early warning scoreQuality improvement

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Area of Science:

  • Pediatric critical care
  • Health services research
  • Patient safety

Background:

  • Paediatric Early Warning Scores (PEWS) are vital for identifying and managing clinical deterioration in children.
  • The Dutch Ministry of Health mandated PEWS implementation in 2011 to enhance patient safety in pediatric wards.
  • This study evaluated PEWS implementation outcomes and healthcare professionals' perspectives in Dutch non-university hospitals.

Purpose of the Study:

  • To assess the impact of implementing PEWS systems in Dutch non-university hospitals.
  • To understand healthcare professionals' attitudes and experiences with PEWS systems.
  • To identify challenges and facilitators for successful PEWS integration into clinical practice.

Main Methods:

  • Quantitative data collected via retrospective patient record review (n=554) at three time points.
  • Semi-structured interviews (n=8) with healthcare professionals to explore implementation experiences.
  • Inductive thematic analysis of interview transcripts.

Main Results:

  • Significant increase in PEWS recording (69.2%) after 1 year, with appropriate action taken in 49.1% of elevated cases.
  • Varied PEWS parameters and policies across hospitals; no system in place at baseline.
  • Professionals acknowledged PEWS importance but expressed concerns about validity and effectiveness; integration into electronic records facilitated use.

Conclusions:

  • Hospitals demonstrated improved PEWS utilization, though success varied.
  • Staff concerns regarding PEWS validity, effectiveness, and inter-hospital communication pose challenges to sustained implementation.
  • Development of a national PEWS system with a core set of parameters, cut-off points, and interventions is recommended.