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Development, implementation and evaluation of an evidence-based paediatric early warning system improvement

Davina Allen1, Amy Lloyd2, Dawn Edwards3

  • 1School of Healthcare Sciences, Cardiff University, Room 13.08, Eastgate House, Newport Road, Cardiff, CF24 0AB, UK. allenda@cardiff.ac.uk.

BMC Health Services Research
|January 3, 2022
PubMed
Summary

Implementing a paediatric early warning system (PUMA Programme) improved clinical outcomes in UK hospitals. Further research into rare event metrics is needed to enhance paediatric patient safety.

Keywords:
Healthcare improvementPaediatric early warning systemsQuality improvement

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Area of Science:

  • Healthcare Improvement
  • Paediatric Patient Safety
  • Clinical Systems Analysis

Background:

  • United Kingdom paediatric mortality rates are high, with clinically missed deterioration as a contributing factor.
  • A systems approach is needed to address this complex issue, as single interventions have limited evidence.
  • Existing research underscores the necessity of integrated strategies for improving paediatric care.

Purpose of the Study:

  • To develop and implement an evidence-based paediatric early warning system improvement programme (PUMA Programme) in UK hospitals.
  • To evaluate the impact of the PUMA Programme on clinical outcomes using quantitative and qualitative methods.
  • To assess the feasibility and effectiveness of contextually tailored system changes in improving paediatric patient safety.

Main Methods:

  • The PUMA Programme was implemented in four UK hospitals (general and tertiary) using a propositional model, assessment tools, and structured facilitation.
  • Interrupted time series analysis and qualitative case studies were employed for evaluation.
  • A composite metric of adverse events (mortality, arrests, unplanned ICU/Higher Dependency Unit admissions) was the primary outcome measure.

Main Results:

  • All participating hospitals identified areas for improvement and implemented contextually appropriate system changes.
  • Three sites showed a decline in the adverse event rate trend.
  • One site with strong organizational support for system-wide changes demonstrated a significant decline in adverse events (ß = -0.09, p < 0.001).

Conclusions:

  • System-level improvements in paediatric early warning systems can positively impact clinical outcomes.
  • The study highlights the need for alternative outcome measures and methodological advancements for rare events in paediatric research and quality improvement.
  • Investment in novel metrics and methodologies can further enhance the potential of programmes like PUMA to reduce paediatric mortality and morbidity.