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Development of an evidence-based ESCALATION system for recognition and response to paediatric clinical deterioration
Fenella J Gill1, Alannah Cooper1, Pania Falconer1
1School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia; Perth Children's Hospital, Child & Adolescent Health Services, Western Australia, Australia.
Insights
This study developed an evidence-based paediatric early warning system (PEWS) for infants and children. The novel system enhances early recognition of clinical deterioration and improves care escalation, incorporating family concerns.
Area of Science:
- Pediatric healthcare
- Clinical informatics
- Patient safety
Background:
- Effective early warning systems are crucial for recognizing clinical deterioration in pediatric patients.
- Existing systems may not adequately address diverse healthcare settings or barriers to care escalation.
- Incorporating family and clinician concerns is vital for timely intervention.
Purpose of the Study:
- To develop an evidence-based paediatric early warning system (PEWS) for infants and children.
- To address barriers to escalating care in various pediatric healthcare contexts.
- To integrate human factors and family involvement into the system design.
Main Methods:
- A three-stage intervention development framework was employed.
- This included evidence review, stakeholder engagement, action research cycles, and prototyping.
- Human factor principles and a structured patient assessment approach were incorporated.
Main Results:
- A prototype PEWS was developed, integrating clinician and family concerns.
- The system features age-specific charts with weighted variables for a composite early warning score.
- A communication framework (iSoBAR NOW) supports the escalation pathway.
Conclusions:
- The developed ESCALATION system promotes critical thinking and situational awareness for early recognition of pediatric clinical deterioration.
- It facilitates timely and effective escalation of care.
- The novel inclusion of family involvement enhances the system's effectiveness.
Aim:
The aim of this study was to develop an evidence-based paediatric early warning system for infants and children that takes into consideration a variety of paediatric healthcare contexts and addresses barriers to escalation of care.
Methods:
A three-stage intervention development framework consisted of Stage 1: evidence review, benchmarking, stakeholder (health professionals, decision-makers, and health consumers) engagement, and consultation; Stage 2: planning and coproduction by the researchers and stakeholders using action research cycles; and Stage 3: prototyping and testing.
Results:
A prototype evidence-based system incorporated human factor principles, used a structured approach to patient assessment, promoted situational awareness, and included family as well as clinician concern. Family involvement in detecting changes in their child's condition was supported by posters and flyers codesigned with health consumers. Five age-specific observation and response charts included 10 weighted variables and one unweighted variable (temperature) to convey a composite early warning score. The escalation pathway was supported by a targeted communication framework (iSoBAR NOW).
Conclusion:
The development process resulted in an agreed uniform ESCALATION system incorporating a whole-system approach to promote critical thinking, situational awareness for the early recognition of paediatric clinical deterioration as well as timely and effective escalation of care. Incorporating family involvement was a novel component of the system.
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