Related Experiment Video
Updated: Jul 16, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Pediatric Early Warning Score in interhospital ambulance care: a pilot study exploring feasibility and impact
Marie Luijmes1, Jikke Stevens2, Nicolette Diets3
1Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands. Marie.Luijmes@radboudumc.nl.
Insights
The Dutch-Ambulance-PEWS (DA-PEWS) pilot study shows improved situational awareness and communication in interhospital pediatric transfers. Further work is needed to address organizational variations for nationwide implementation.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Systems Research
- Patient Safety
Background:
- Pediatric Early Warning Scores (PEWS) are crucial for recognizing clinical deterioration in children.
- A national Dutch PEWS was developed in 2019 for pediatric hospital care.
- Improving interhospital transfer communication is vital for the chain of care.
Purpose of the Study:
- To explore the feasibility and impact of the Dutch PEWS in interhospital ambulance care.
- To adapt the Dutch PEWS for ambulance use, creating the Dutch-Ambulance-PEWS (DA-PEWS).
- To assess the potential for nationwide implementation of DA-PEWS.
Main Methods:
- The Plan-Do-Study-Act (PDSA) cycle guided the adoption and implementation of DA-PEWS.
- Implementation occurred in one ambulance region (Regional Ambulance Service Utrecht - RAVU).
- Feasibility and impact were evaluated using questionnaires and semi-structured interviews over twelve months.
Main Results:
- DA-PEWS enhanced situational awareness, communication uniformity, and protocol adherence during interhospital transfers.
- The system was deemed feasible for interhospital ambulance care.
- Challenges for nationwide upscaling include organizational variations, transfer frequency, and individual attitudes.
Conclusions:
- The pilot demonstrated the impact of DA-PEWS in Dutch interhospital ambulance care.
- Local contextual factors are critical for successful nationwide implementation.
- Lessons learned will inform broader dissemination strategies for DA-PEWS.
Background:
Pediatric Early Warning Scores (PEWS) are commonly used for early recognition of clinical deterioration in hospitalized children and timely intervention. In 2019, a national Dutch PEWS was developed for pediatric hospital care in the Netherlands. To improve communication during interhospital transfers, using Dutch PEWS in interhospital ambulance care might be of added value in the chain of care. Therefore, this pilot study aimed to explore the feasibility and impact of the Dutch PEWS in interhospital ambulance care.
Methods:
Using the Plan-Do-Study-Act cycle, a four-step model for carrying out change, the Dutch PEWS system was first adopted for use in interhospital ambulance care, resulting in Dutch-Ambulance-PEWS (DA-PEWS) (Plan). This system was implemented in one ambulance region: the Regional Ambulance Service Utrecht (RAVU) (Do). Feasibility for implementing DA-PEWS nationwide and impact were evaluated. To do so, one baseline questionnaire and semi-structured interviews at the start of and at three, six, and twelve months after implementation were used (Study). Based on the results, approaches were developed to disseminate the DA-PEWS to national ambulance care (Act).
Results:
Main impact themes that emerged included the enhancement of situational awareness, communication in the chain of care through improvements in uniformity and handovers and improved protocol adherence. Using the system in the interhospital care setting was considered feasible, but for future upscaling of the implementation and efficacy, determinants such as variation in organizational structures, the limited frequency of pediatric interhospital transfers and differences in individual attitudes toward using one system are first steps to consider.
Conclusion:
This pilot study showed impact of using the DA-PEWS in interhospital ambulance care in the Netherlands, while also revealing important lessons for the implementation of the DA-PEWS nationwide due to local contextual factors in the organization of ambulance care across regions.
More Related Videos
11:27A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
05:15Amplitude-Integrated EEG in Infants at Risk of Hypoxic-Ischemic Encephalopathy: A Feasibility Study in Road and Air Transport in Western Australia
Published on: June 21, 2024