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Implementation of a PEWS-integrated electronic SBAR handover model for pediatric inpatients: A nonconcurrent
Huali Huang1, Bo Liu2, Xiaowan Gu1
1Department of Pediatrics, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, People's Republic of China.
Insights
Implementing an electronic Situation-Background-Assessment-Recommendation (SBAR) handover model integrated with a pediatric early warning score improved handover quality and efficiency. This enhanced model reduced errors and nursing adverse events in pediatric inpatient care.
Area of Science:
- Pediatric Healthcare
- Clinical Informatics
- Patient Safety
Background:
- Effective patient handover is crucial for pediatric patient safety.
- Traditional handover methods can be prone to errors and inefficiencies.
- Integrating electronic tools with standardized communication models can potentially improve handover processes.
Purpose of the Study:
- To evaluate the impact of a pediatric early warning score-integrated electronic Situation-Background-Assessment-Recommendation (SBAR) handover model on observed changes in pediatric inpatient handover.
- To assess improvements in handover quality, efficiency, satisfaction, and safety-related indicators.
- To compare outcomes between a routine SBAR handover and the new integrated electronic SBAR model.
Main Methods:
- A single-center, nonconcurrent controlled study was conducted in three general pediatric wards.
- Data were collected during a control period (routine SBAR) and an intervention period (electronic SBAR with pediatric early warning score integration).
- Outcomes included bedside handover quality, nurse/family evaluations, handover errors, efficiency, unplanned PICU transfers, and nursing adverse events.
Main Results:
- The intervention period showed significantly higher bedside handover quality, nurse handover evaluation, and family perception scores compared to the control period.
- Handover error rates decreased significantly (6.84% vs 17.97%).
- Report-writing and bedside handover times were significantly shorter, indicating improved efficiency. Nursing adverse events were also less frequent (4.72% vs 11.17%).
Conclusions:
- The pediatric early warning score-integrated electronic SBAR handover model is associated with enhanced handover quality, efficiency, and safety.
- The model led to higher satisfaction among nurses and families, with fewer errors and adverse events.
- Further multicenter prospective studies are recommended to validate these findings and confirm the impact on unplanned PICU transfers.
Abstract:
This study aimed to evaluate observed changes in pediatric inpatient handover quality, efficiency, satisfaction, and safety-related indicators after implementation of a pediatric early warning score-integrated electronic Situation-Background-Assessment-Recommendation (SBAR) handover model. This single-center nonconcurrent controlled study was conducted in 3 general pediatric wards of a tertiary hospital in Jingzhou, China. The control period was January to March 2024 with routine SBAR handover, and the intervention period was June to August 2024 after development, electronic integration, and staff training. The same 47 pediatric nurses participated in both periods. The control period included 206 children and 384 handover observations; the intervention period included 212 children and 395 observations. Outcomes included bedside handover quality, nurse handover evaluation, family bedside handover perception, handover errors, handover efficiency, unplanned pediatric intensive care unit (PICU) transfer, and nursing adverse events. Because of the nonconcurrent design, findings were interpreted as observed between-period differences rather than direct causal effects. During the intervention period, bedside handover quality, nurse handover evaluation, and family bedside handover perception scores were higher than during the control period (93.66 ± 9.52 vs 83.93 ± 8.86; 58.21 ± 7.24 vs 52.51 ± 5.21; 63.23 ± 3.51 vs 55.59 ± 3.71; all P < .001). The handover error rate was lower (6.84% vs 17.97%, P < .01). Report-writing time and bedside handover time were shorter (2.11 ± 0.41 vs 4.51 ± 0.32 minutes and 3.94 ± 0.63 vs 5.97 ± 0.31 minutes; both P < .001). The unplanned PICU transfer rate was numerically lower (0.94% vs 3.88%), but this finding was borderline and not statistically significant by Fisher's exact test (P = .059). Nursing adverse events were less frequent during the intervention period (4.72% vs 11.17%, P = .015). Implementation of a pediatric early warning score-integrated electronic SBAR handover model was associated with better handover quality, higher nurse and family evaluations, improved efficiency, fewer handover errors, and fewer observed nursing adverse events. The lower unplanned PICU transfer rate should be interpreted cautiously. Multicenter prospective studies are needed to confirm these findings.
