A Quality Improvement Project to Promote Interdisciplinary Communication Using the Pediatric Early Warning System

In August 2020, residents and nurses lacked awareness and knowledge of the pediatric early warning system (PEWS). Residents and nurses infrequently performed interdisciplinary bedside huddles for patients with critical scores, and residents did not document assessments and plans despite these patients being at higher risk for clinical deterioration. We aimed to increase the mean rate of documented huddles from 0% to 50% within 4 months.

We piloted this quality improvement project on 1 floor of a pediatric hospital and included patients admitted to the pediatric hospital medicine service. Key drivers included buy-in and trust in PEWS, understanding of critical scores, a reliable scoring algorithm, and a culture where interdisciplinary communication is routine. Interventions included physician and nurse education, improving the scoring algorithm, and promoting a shared understanding of PEWS. Our outcome measure was the percentage of documented huddle notes for each patient with a critical score, a proxy for huddles occurring. We entered data into a control chart and analyzed it for changes in response to interventions.

The mean baseline rate of note completion was 0%. After 4 months, the mean increased to 100%, associated with multiple educational interventions and efforts to improve the scoring algorithm.

Implementing multimodal interventions was associated with an increased rate of documented huddles. Scoring algorithm changes and personalized education galvanized physician and nurse support for PEWS. Institutions can use the lessons we have learned to implement PEWS and promote huddles and interdisciplinary communication.