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Intensive Crit Care Nurs. 2015 Apr;31(2):91-9. doi: 10.1016/j.iccn.2014.01.001. Epub 2014 May 28.

What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study.

Author information

  • 1PICU, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom. Electronic address:
  • 2PICU, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom.
  • 3University of Liverpool, Brownlow Hill, Liverpool L69 7ZX, United Kingdom.
  • 4John Moores University, Byrom Street, Liverpool L3 3AF, United Kingdom.


The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes.


To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs).


A before-and-after observational study August 2005-July 2006 (pre), August 2006-July 2007 (post) implementation of PEWs at the tertiary children's hospital.


The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (p<0.001). Fewer admissions required invasive ventilation 62.7% vs 75.2% (p=0.015) for a shorter median duration; four to two days. The median length of PICU stay reduced; five to three days (p=0.002). There was a non-significant reduction in mortality (p=0.47). There was no comparable improvement in outcome seen in external emergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals.


Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved.

Copyright © 2014 Elsevier Ltd. All rights reserved.


Child; Deterioration; Emergency; PEW; PICU; Paediatric; Paediatric Early Warning; Pediatric; Unplanned admission to PICU

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