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A Quality Improvement Initiative to Reduce Unnecessary Rapid Responses Using Early Warning Scores

Scott W Penney1, Scarlett N O'Hara-Wood1, Lisa M McFarlan1

  • 1San Antonio Uniformed Services Health Education Consortium, Department of Pediatrics, Brooke Army Medical Center, Joint Base San Antonio Fort Sam Houston, Texas.

Pediatrics
|February 6, 2021
PubMed

Insights

Implementing a Pediatric Early Warning Score (PEWS) significantly reduced unnecessary rapid response team (RRT) activations in pediatric care. This evidence-based tool improved patient safety and communication without increasing PICU transfers.

Area of Science:

  • Pediatric critical care medicine
  • Quality improvement initiatives
  • Patient safety systems

Background:

  • The Pediatric Early Warning Score (PEWS) is an evidence-based tool designed for early assessment and intervention in pediatric patients.
  • Rapid Response Team (RRT) activation criteria based solely on vital signs can lead to unnecessary activations.
  • A quality improvement initiative aimed to optimize PEWS for reduced RRT activations.

Purpose of the Study:

  • To decrease unnecessary RRT activations by 50% over two years.
  • To maintain or improve patient safety and timely evaluations.
  • To evaluate the impact of PEWS implementation on RRT activation rates and patient outcomes.

Main Methods:

  • A PEWS system replaced existing vital signs-based RRT criteria.
  • The PEWS system underwent modifications using plan-do-study-act cycles.
  • Key metrics including unnecessary RRT activations, total RRT activations, PICU transfers, and clinical interventions were compared pre- and post-implementation.

Main Results:

  • Unnecessary RRT activations decreased significantly from 33% to 3.5% (P < .05).
  • The overall RRT activation rate reduced from 22.6 to 13.3 per 1000 patient care days (P < .05).
  • PICU transfer rates remained unchanged, and physician and nursing satisfaction with communication and patient management improved.

Conclusions:

  • PEWS systems are effective in identifying deteriorating pediatric patients and reducing unnecessary RRT activations.
  • The PEWS system enhances bedside collaboration and communication, preventing acute deterioration.
  • Implementation of PEWS ultimately improves patient safety and clinical outcomes in pediatric care.
Abstract

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