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Implementing a national Dutch PEWS system in 12 hospitals with different contexts: opportunities, challenges and
Jikke Stevens1,2, Tessa de Jong3, Michèl A Willemsen3
1Pediatrics, Radboudumc, Nijmegen, The Netherlands Jikke.Stevens@radboudumc.nl.
Insights
Successful implementation of the Dutch Paediatric Early Warning Score (PEWS) relies on adaptable design and national use. This approach enhances timely detection of child deterioration and improves healthcare efficiency nationwide.
Area of Science:
- Pediatric healthcare quality improvement
- Clinical informatics and patient safety
- Health services research
Background:
- Significant heterogeneity exists in Paediatric Early Warning Score (PEWS) systems globally, impacting timely detection of deterioration in hospitalized children.
- The Dutch PEWS was developed for national standardization, integrating core vital and watcher signs with local adaptation options.
- This study aimed to identify factors for successful Dutch PEWS implementation and assess the value of local adaptation.
Purpose of the Study:
- To determine key factors contributing to the successful implementation of the Dutch Paediatric Early Warning Score (PEWS).
- To evaluate the extent of local adaptation and its perceived value among healthcare providers.
- To assess the impact of a standardized, yet adaptable, PEWS on pediatric patient safety.
Main Methods:
- A multicenter, mixed-methods study involving 12 hospitals of varying types (University Medical Centers to general hospitals).
- Data collection utilized a Plan-Do-Study-Act cycle, including questionnaires (n=1127), interviews (n=171), and member checks (n=3).
- Protocol adherence percentage (PAP) was calculated as a primary implementation indicator, with data collected at 3, 6, and 9 months post-implementation.
Main Results:
- Most participants viewed the Dutch PEWS implementation and use positively, citing reduced workload and increased confidence.
- Nationwide utilization facilitated integration into training and electronic health record optimization.
- Protocol adherence varied (47%-140%), with an overall PAP of 81% (±25%); local adaptation was common but varied in extent.
Conclusions:
- Successful implementation of PEWS is linked to system design, local context adaptability, and nationwide utilization.
- Nationwide use enables cross-context evaluation, supporting broader adoption and refinement of PEWS.
- The Dutch PEWS model demonstrates the potential for standardized yet flexible systems to improve pediatric patient safety.
Background:
Worldwide, there is a large heterogeneity of Paediatric Early Warning Score (PEWS) systems to detect deterioration in hospitalised children timely. In the Netherlands, the Dutch PEWS was created to enhance national standardisation, incorporating a core set of vital signs and watcher signs with local adaptation strategies. The primary objective of this study was to determine factors for successful implementation. The secondary objectives were to assess the use and perceived value of local adaptation.
Methods:
In a multicentre study, the Dutch PEWS was implemented in 12 hospitals with different contexts ranging from University Medical Centers to general hospitals. This mixed-methods evaluation study prospectively collected data following the Plan-Do-Study-Act cycle. In preparation for implementation, local adaptation was executed, implementation strategies were formulated and baseline measurements were conducted. Post-implementation measures were performed 3, 6 and 9 months after implementation. In total, 1127 questionnaires and 171 interviews were completed with healthcare providers and 11 interviews and 3 member checks with project leaders. The protocol adherence percentage (PAP) was calculated for each hospital as an indicator for implementation.
Results:
The majority of the participants assessed the implementation and use of the Dutch PEWS positively. Important facilitators include reduced workload, increased confidence in achieving the objective and benefits related to utilisation on a national scale. Nationwide use facilitated further integration into training programmes and optimisation of electronic health record systems. At the same time, local adaptation was used in most hospitals and to varying extents. The overall PAP was 81% (±25%), ranging from 47% to 140%.
Conclusion:
This study demonstrates that successful implementation of PEWS systems is related to their design, adaptability to local contexts and nationwide utilisation. Moreover, nationwide use provides opportunities to evaluate the system across diverse contexts, thereby supporting broader implementation.
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