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Model for regional collaboration: Successful strategy to implement a pediatric early warning system in 36 pediatric
Asya Agulnik1, Alejandra Gonzalez Ruiz1, Hilmarie Muniz-Talavera1
1Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA.
Insights
Proyecto EVAT successfully scaled Pediatric Early Warning Systems (PEWS) across 36 Latin American pediatric oncology centers. This quality improvement collaborative demonstrates a feasible strategy for implementing critical tools in resource-limited settings.
Area of Science:
- Pediatric oncology
- Quality improvement science
- Implementation science
Background:
- Pediatric Early Warning Systems (PEWS) are crucial for identifying deterioration in children with cancer.
- Limited use of PEWS in resource-limited settings hinders timely intervention.
- Proyecto EVAT addresses this gap by focusing on scalable PEWS implementation in Latin America.
Purpose of the Study:
- To describe the implementation strategy of Proyecto EVAT, a multicenter quality-improvement collaborative.
- To scale up the use of PEWS in pediatric oncology centers across Latin America.
- To share lessons learned for future global health initiatives.
Main Methods:
- Utilized the knowledge-to-action framework for a systematic implementation.
- Mentored 36 hospitals across 13 countries in adapting and implementing PEWS.
- Assessed barriers, piloted interventions, monitored usage, and evaluated outcomes.
Main Results:
- Successfully implemented PEWS in 36 diverse hospitals, training over 11,100 clinicians.
- PEWS was used in over 41,000 pediatric cancer admissions.
- Implementation completion averaged 7 months, with high-quality use sustained up to 18 months.
Conclusions:
- Regional scaling of evidence-based interventions like PEWS is achievable through collaborative networks and adaptable strategies.
- Successful implementation requires mentorship and contextual adaptation.
- Lessons from Proyecto EVAT can guide efforts to reduce global disparities in childhood cancer care.
Background:
Pediatric early warning systems (PEWS) aid in the early identification of deterioration in hospitalized children with cancer; however, they are under-used in resource-limited settings. The authors use the knowledge-to-action framework to describe the implementation strategy for Proyecto Escala de Valoracion de Alerta Temprana (EVAT), a multicenter quality-improvement collaborative, to scale-up PEWS in pediatric oncology centers in Latin America.
Methods:
Proyecto EVAT mentored participating centers through an adaptable implementation strategy to: (1) monitor clinical deterioration in children with cancer, (2) contextually adapt PEWS, (3) assess barriers to using PEWS, (4) pilot and implement PEWS, (5) monitor the use of PEWS, (6) evaluate outcomes, and (7) sustain PEWS. The implementation outcomes assessed included the quality of PEWS use, the time required for implementation, and global program impact.
Results:
From April 2017 to October 2021, 36 diverse Proyecto EVAT hospitals from 13 countries in Latin America collectively managing more than 4100 annual new pediatric cancer diagnoses successfully implemented PEWS. The time to complete all program phases varied among centers, averaging 7 months (range, 3-13 months) from PEWS pilot to implementation completion. All centers ultimately implemented PEWS and maintained high-quality PEWS use for up to 18 months after implementation. Across the 36 centers, more than 11,100 clinicians were trained in PEWS, and more than 41,000 pediatric hospital admissions had PEWS used in their care.
Conclusions:
Evidence-based interventions like PEWS can be successfully scaled-up regionally basis using a systematic approach that includes a collaborative network, an adaptable implementation strategy, and regional mentorship. Lessons learned can guide future programs to promote the widespread adoption of effective interventions and reduce global disparities in childhood cancer outcomes.
Lay Summary:
Pediatric early warning systems (PEWS) are clinical tools used to identify deterioration in hospitalized children with cancer; however, implementation challenges limit their use in resource-limited settings. Proyecto EVAT is a multicenter quality-improvement collaborative to implement PEWS in 36 pediatric oncology centers in Latin America. This is the first multicenter, multinational study reporting a successful implementation strategy (Proyecto EVAT) to regionally scale-up PEWS. The lessons learned from Proyecto EVAT can inform future programs to promote the adoption of clinical interventions to globally improve childhood cancer outcomes.
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