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Published on: June 20, 2020
Paediatric early warning systems: not a simple answer to a complex question
Damian Roland1,2, Colin Powell3,4, Amy Lloyd5
1SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK dr98@leicester.ac.uk.
Insights
Paediatric early warning systems (PEWS) aim to reduce child deaths in hospitals. However, their effectiveness is often assumed rather than proven, questioning our understanding of how PEWS truly function and impact patient outcomes.
Area of Science:
- Pediatric critical care
- Health systems research
- Patient safety
Background:
- Paediatric early warning systems (PEWS) are increasingly implemented to improve outcomes in children.
- Existing evaluations often overlook the internal validity of PEWS components.
- Assumptions about PEWS' mechanisms of action are common.
Purpose of the Study:
- To critically evaluate the assumptions underlying the design and implementation of PEWS.
- To question the current understanding of PEWS function, process, and outcome.
- To prompt a deeper examination of PEWS' impact on in-hospital mortality.
Main Methods:
- Review of existing literature on PEWS implementation and evaluation.
- Analysis of the theoretical underpinnings and assumed causal pathways of PEWS.
- Critical assessment of the evidence supporting PEWS' effectiveness.
Main Results:
- Limited examination of the internal validity of PEWS components in prior studies.
- Widespread reliance on assumptions regarding how PEWS achieve desired outcomes.
- Growing prevalence of PEWS without a comprehensive understanding of their function.
Conclusions:
- The effectiveness of PEWS may be overestimated due to unverified assumptions.
- Further research is needed to rigorously assess the function, process, and outcomes of PEWS.
- A more critical approach to PEWS evaluation is necessary to ensure patient safety and reduce mortality.
Abstract:
Paediatric early warning systems (PEWS) to reduce in-hospital mortality have been a laudable endeavour. Evaluation of their impact has rarely examined the internal validity of the components of PEWS in achieving desired outcomes. We highlight the assumptions made regarding the mode of action of PEWS and, as PEWS become more commonplace, this paper asks whether we really understand their function, process and outcome.
