Objective To describe how existing processes can be altered to implement a Paediatric Early Warning System (PEWs).
Background Two audits of unplanned admissions from wards(UAW) to PICU and HDU pre-PEWs showed 83–88% of patients had documented signs of clinical deterioration for up to 24 hours prior to critical care admission. It was hoped that earlier recognition of deteriorating patients would improve the success of treatment. The specific requirements for monitoring and observation of in-patients were made policy. Observation charts were updated to incorporate an APLS approach to assessment and include a validated PEW tool. Processes were formalised for gaining a prompt medical review when the PEWs was triggered.
Method PEWs activation was recorded electronically via the patient information system. Data was analysed prospectively to assess: What are the characteristics of patients triggering PEWs? What was their outcome? What impact did a PEWs have on PICU and HDU utilisation? What is the impact on staff workload of prioritising response to PEWs triggers?
Results ‘High risk’ patients identified were: <1 year, males, underlying cardiac diagnoses OR oncological/haematological diagnoses. 21.8%(n = 136) of PEW triggers requiring PICU,HDU or 1:1 nursing. PICU UAW were marginally increased, but total bed days for UAW reduced by 21% (IQR 37%). HDU UAW reduced by 5% of total admissions. Total bed days reduced by 11% (IQR 39%).
Conclusion Patient safety can be improved by implementing a robust PEWs. Early identification and prompt action once PEWs is triggered can reduce critical care admissions, or reduce length of stay.
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