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Health professionals' initial experiences and perceptions of the acceptability of a whole-hospital, pro-active
Bernie Carter1, Holly Saron2, Sarah Siner3
1Edge Hill University, Ormskirk, UK. bernie.carter@edgehill.ac.uk.
Insights
Paediatric early warning systems (PEWS) improve patient outcomes. The DETECT electronic-PEWS showed good acceptability among nurses documenting vital signs, but varied among those responding to alerts.
Area of Science:
- Pediatric critical care
- Health informatics
- Clinical decision support systems
Background:
- Paediatric early warning systems (PEWS) are crucial for detecting child deterioration.
- Electronic PEWS (e-PEWS) may offer advantages over paper-based systems.
- The DETECT study evaluated the DETECT e-PEWS in a UK tertiary children's hospital.
Purpose of the Study:
- To explore health professionals' initial experiences with DETECT e-PEWS.
- To assess the acceptability of DETECT e-PEWS.
- To identify factors influencing the acceptability of DETECT e-PEWS.
Main Methods:
- A descriptive qualitative study using semi-structured telephone interviews.
- Participants included health professionals (nurses and doctors) using DETECT e-PEWS.
- Thematic analysis of transcripts from two user groups: documenting vital signs (D-VS) and responding to vital signs (R-VS).
Main Results:
- Fourteen health professionals participated (7 D-VS, 7 R-VS).
- The D-VS group reported good clinical utility and acceptability.
- The R-VS group showed diverse perceptions; nurses found it more acceptable than doctors, impacting overall system engagement.
Conclusions:
- Key factors for acceptability include real-time data, automated alerts, and improved situational awareness.
- Mandating both recording and responding functions is essential for full DETECT e-PEWS implementation.
- Addressing user-specific perceptions, particularly among doctors in the R-VS group, is vital for system success.
Background:
Paediatric early warning systems (PEWS) alert health professionals to signs of a child's deterioration with the intention of triggering an urgent review and escalating care. They can reduce unplanned critical care transfer, cardiac arrest, and death. Electronic systems may be superior to paper-based systems. The objective of the study was to critically explore the initial experiences and perceptions of health professionals about the acceptability of DETECT e-PEWS, and what factors influence its acceptability.
Methods:
A descriptive qualitative study (part of The DETECT study) was undertaken February 2020-2021. Single, semi-structured telephone interviews were used. The setting was a tertiary children's hospital, UK. The participants were health professionals working in study setting and using DETECT e-PEWS. Sampling was undertaken using a mix of convenience and snowballing techniques. Participants represented two user-groups: 'documenting vital signs' (D-VS) and 'responding to vital signs' (R-VS). Perceptions of clinical utility and acceptability of DETECT e-PEWS were derived from thematic analysis of transcripts.
Results:
Fourteen HPs (12 nurses, 2 doctors) participated; seven in D-VS and seven in the R-VS group. Three main themes were identified: complying with DETECT e-PEWS, circumventing DETECT e-PEWS, and disregarding DETECT e-PEWS. Overall clinical utility and acceptability were deemed good for HPs in the D-VS group but there was diversity in perception in the R-VS group (nurses found it more acceptable than doctors). Compliance was better in the D-VS group where use of DETECT e-PEWS was mandated and used more consistently. Some health professionals circumvented DETECT e-PEWS and fell back into old habits. Doctors (R-VS) did not consistently engage with DETECT e-PEWS, which reduced the acceptability of the system, even in those who thought the system brought benefits.
Conclusions:
Speed and accuracy of real-time data, automation of triggering alerts and improved situational awareness were key factors that contributed to the acceptability of DETECT e-PEWS. Mandating use of both recording and responding aspects of DETECT e-PEWS is needed to ensure full implementation.
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