Format

Send to

Choose Destination
BMC Emerg Med. 2019 Nov 27;19(1):74. doi: 10.1186/s12873-019-0287-5.

Implementation study of a 5-component pediatric early warning system (PEWS) in an emergency department in British Columbia, Canada, to inform provincial scale up.

Author information

1
Child Health BC, 260 - 1770 West 7th Ave., Vancouver, BC, V6J 4Y6, Canada. theresa.mcelroy@cw.bc.ca.
2
University of British Columbia, Faculty of Medicine, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. theresa.mcelroy@cw.bc.ca.
3
Vancouver Coastal Health, 604-601 Broadway Ave., Vancouver, BC, V5Z 4C2, Canada. theresa.mcelroy@cw.bc.ca.
4
University of British Columbia, Faculty of Medicine, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
5
Vancouver Coastal Health, 604-601 Broadway Ave., Vancouver, BC, V5Z 4C2, Canada.
6
Provincial Health Services Authority, 200-1333 West Broadway Ave., Vancouver, BC, V6H 4C1, Canada.
7
Child Health BC, 260 - 1770 West 7th Ave., Vancouver, BC, V6J 4Y6, Canada.

Abstract

BACKGROUND:

The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up.

METHODS:

We used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient medical records, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches.

RESULTS:

The majority of medical¬†records had documented PEWS scores at triage (80%) and first bedside assessment (81%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (>‚ÄČ100% increase), in improving staff's self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of PEWS and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED.

CONCLUSION:

Our study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.

KEYWORDS:

Emergency department; Implementation study; Mixed methods; PEWS; Pediatric early warning score; Pediatric early warning system; Pediatrics

Supplemental Content

Full text links

Icon for BioMed Central Icon for PubMed Central
Loading ...
Support Center