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Qualitative Study of Pediatric Early Warning Systems' Impact on Interdisciplinary Communication in Two Pediatric
Dylan Graetz1, Erica C Kaye1, Marcela Garza1
1St. Jude Children's Research Hospital, Memphis, TN.
Insights
Pediatric early warning systems (PEWS) empower bedside providers, improving communication for hospitalized oncology patients. However, hierarchy and technology can impede communication, highlighting the need for contextual optimization of PEWS.
Area of Science:
- Pediatric Oncology
- Healthcare Communication
- Clinical Systems
Background:
- Hospitalized pediatric oncology patients face high risks of deterioration.
- Effective interdisciplinary communication is crucial for high-quality care in these settings.
- The impact of Pediatric Early Warning Systems (PEWS) on communication in varying resource settings is not well understood.
Purpose of the Study:
- To explore how Pediatric Early Warning Systems (PEWS) influence interdisciplinary communication in pediatric oncology settings.
- To compare the effects of PEWS on communication in high-resource (United States) and limited-resource (Guatemala) settings.
Main Methods:
- Qualitative study utilizing semistructured interviews with healthcare providers at two pediatric cancer centers.
- Inclusion of nurses, frontline, and intensive care providers who experienced recent patient deterioration events.
- Inductive thematic analysis of interview transcripts using MAXQDA software.
Main Results:
- Identified key themes: hierarchy, empowerment, quality/method of communication, and trigger.
- PEWS were perceived as empowering by providers in both settings.
- Hierarchical structures negatively impacted communication quality; US providers noted technology/automation impaired judgment and communication, while both settings saw PEWS spark communication and action.
Conclusions:
- PEWS enhance interdisciplinary communication by empowering bedside providers across different resource levels.
- Traditional hierarchies and, in well-resourced settings, technology/automation can hinder communication.
- Optimizing PEWS requires understanding contextual factors to improve pediatric oncology outcomes globally.
Purpose:
Hospitalized pediatric oncology patients are at high risk of deterioration and require frequent interdisciplinary communication to deliver high-quality care. Pediatric early warning systems (PEWS) are used by hospitals to reduce deterioration, but it is unknown how these systems affect communication about patient care in high- and limited-resource pediatric oncology settings.
Methods:
This qualitative study included semistructured interviews describing PEWS and subsequent team communication at 2 pediatric cancer centers, 1 in the United States and 1 in Guatemala. Participants included nurses, and frontline and intensive care providers who experienced recent deterioration events. Transcripts were coded and analyzed inductively using MAXQDA software.
Results:
The study included 41 providers in Guatemala and 42 providers in the United States (33 nurses, 30 ward providers, and 20 pediatric intensive care providers). Major themes identified include "hierarchy," "empowerment," "quality and method of communication," and "trigger." All providers described underlying medical hierarchies affecting the quality of communication regarding patient deterioration events and identified PEWS as empowering. Participants from the United States described the algorithmic approach to care and technology associated with PEWS contributing to impaired clinical judgement and a lack of communication. In both settings, PEWS sparked interdisciplinary communication and inspired action.
Conclusion:
PEWS enhance interdisciplinary communication in high- and limited-resource study settings by empowering bedside providers. Traditional hierarchies contributed to negative communication and, in well-resourced settings, technology and automation resulted in lack of communication. Understanding contextual elements is integral to optimizing PEWS and improving pediatric oncology outcomes in hospitals of all resource levels.
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