Implementation of a pediatric early warning scale to identify clinical deterioration in a pediatric general ward

Introduction. Clinical deterioration in hospitalized pediatric patients is often preceded by early signs that healthcare personnel may not recognize. Implementing validated early warning systems, such as the EWAS (Early Warning Assessment Scale), aims to improve early detection of clinical deterioration. We describe the process of implementing EWAS in a general pediatric ward and analyze its impact on the incidence of clinical deterioration events and their morbidity and mortality. Methods. Before-and-after study. Patients with clinical deterioration events before and after EWAS implementation were included. Event rates, mortality, and critical interventions in the general ward were compared. Results. There were 7.64 events per 1000 patient days pre-implementation and 6.42 per 1000 patient days post-implementation (p = 0.34). Associated mortality decreased from 9.43% to 3.03% (p = 0.14). There were no significant differences in mechanical ventilation, inotropics, or length of stay. A significant reduction in critical interventions performed in the general ward was observed: 15.4% pre-implementation vs. 3.0% post-implementation (p = 0.01). The error rate in EWAS use remained <15% throughout the implementation. Conclusion. The implementation of EWAS was feasible and had good adherence. Although no significant differences in mortality were observed, the reduction in critical interventions outside the PICU suggests improved identification and response to clinical deterioration, which is why we consider EWAS a useful tool in the context of care safety strategies.