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Implementing a paediatric early warning score into pre-hospital practice
1North West Ambulance Service.
Insights
Ambulance clinicians can safely and effectively use the Paediatric Observations Priority Score (POPS) for assessing unwell children. This tool improved clinician confidence and competence in evaluating pediatric patients in pre-hospital settings.
Area of Science:
- Pediatric Emergency Medicine
- Pre-hospital Care
- Clinical Assessment Tools
Background:
- Ambulance clinicians require enhanced education for assessing unwell children.
- A validated Paediatric Early Warning Score (PEWS) was explored for pre-hospital use.
Purpose of the Study:
- To evaluate the safety and effectiveness of the Paediatric Observations Priority Score (POPS) in pre-hospital pediatric care.
- To assess improvements in ambulance clinicians' confidence and competence in examining unwell children.
Main Methods:
- A validated PEWS, the POPS, was implemented in pre-hospital practice.
- Clinician confidence and competence were surveyed before and after the trial.
- Interrater reliability of the POPS was calculated using patient report forms.
Main Results:
- Interrater reliability for POPS was found to be moderate (Kappa coefficient = 0.401).
- Clinician self-reported confidence and competence significantly improved across all assessed pediatric patient presentations.
- POPS demonstrated reliability in scoring, with decreased variance as scores increased.
Conclusions:
- The POPS is a safe and effective tool for ambulance clinicians assessing unwell children.
- Implementation of POPS led to enhanced self-reported confidence and competence among pre-hospital clinicians.
- POPS aids in identifying critically unwell children and those suitable for discharge.
Aim:
This study addressed a desire by ambulance clinicians for additional education in the examination and assessment of the unwell child; it also explored whether ambulance clinicians could use a paediatric early warning score (PEWS) safely and effectively in the pre-hospital arena.
Methods:
A small-scale study introduced a validated PEWS into pre-hospital practice. The paediatric observations priority score (POPS) combines physiological observations with clinicians' review. POPS uses a range of proxy measures such as work of breathing, alertness, gut feeling and known high-risk factors, to further refine the scoring. Based on a sample of over 24,000 patients, POPS has been validated for use in emergency departments (EDs). POPS can identify potentially critically unwell children as well as those fit for discharge without hospital admission, the fundamental purpose of an ED.Study participants were surveyed before and after the trial period in order to examine self-reported scores in confidence and competence levels for the child in pain, the breathless child, the child with a decreased level of consciousness, the febrile child and the seriously injured child.Completed patient report forms (PRFs) were returned to the principal investigator for further analysis. PRFs were re-distributed among participants for rescoring. Once rescoring was completed, the PRFs were returned to the principal investigator for calculation of interrater reliability. Participants remained anonymous for the survey.
Results:
Interrater reliability (Kappa coefficient) was calculated as 0.401, which is considered moderate agreement. As POPS rose, variance decreased. Lower POPS had variance, but these patients were lower acuity. Equal scoring in the main was reliable.
Conclusion:
For a cohort of ambulance clinicians, POPS was found to be safe and effective. Self-reported levels in confidence and competence improved in all patient presentations when comparing before and after the trial period (Table 1). [Table: see text].
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