Article Text

Download PDFPDF
Implementation of a paediatric early warning system as a complex health technology intervention
  1. Heather Duncan1,
  2. Adrienne P Hudson2,3
  1. 1 PICU, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
  2. 2 Department of Paediatrics, University of Queensland, Brisbane, Queensland, Australia
  3. 3 Learning and Workforce, Queensland Health, Brisbane, Queensland, Australia
  1. Correspondence to Dr Heather Duncan, PICU, Birmingham Children's Hospital NHS Foundation Trust, Birmingham B4 6NH, UK; heather.duncan5{at}


The national implementation groups of early warning systems in the UK and Ireland have identified a need to understand implementation, adoption and maintenance of these complex interventions. The literature on how to implement, scale, spread and sustain these systems is sparse. We describe a successful adoption and maintenance over 10 years of a paediatric early warning system as a sociotechnical intervention using the Nonadoption, Abandonment, Challenges to the Scale-Up, Spread, and Sustainability Framework for Health and Care Technologies. The requirement for iterative processes within environment, culture, policy, human action and the wider system context may explain the possible reasons for improved outcomes in small-scale implementation and meta-analyses that are not reported in multicentre randomised control trials of early warning systems.

  • health services research
  • intensive care
  • resuscitation

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. No data are available.