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Abstract
Late detection of clinical deterioration in hospitalised children leads to increased morbidity and mortality and is potentially preventable. Our Trust has recently changed Paediatric Early Warning System (PEWS) to the Bedside PEWS, a documentation-based system of care with a built-in escalation algorithm, and communication tool, empowering prompt escalation of care.
We hypothesised that implementation of Bedside PEWS would result in improved early detection of critical illness and medical intervention resulting in more stable physiology on admission to critical care and a reduction in adverse incidents (AIs) associated with late detection of deteriorating patients.
We compared patients’ physiological parameters (pH, lactate, heart rate and respiratory rate) and length of stay (LOS) for those admitted to critical care from four paediatric wards, before and after bedside PEWS implementation, for six months before and after bedside PEWS implementation.
Results The table demonstrates data for all children admitted to critical care from the wards in the time period (All pre and All post) and data selected for patients with a respiratory diagnosis (Respiratory pre and Respiratory post). Data is demonstrated as median (range) or mean (Standard deviation).
There were eight AIs on the wards related to failure to detect the deteriorating child prior to implementation and only three subsequently.
Conclusion These data suggest that following implementation of Bedside PEWS, children were referred earlier in a better physiological state to critical care than prior to implementation, suggesting improved ward-based care, especially in general paediatric respiratory patients. This is despite children post-implementation being younger and having a longer LOS on critical care, suggesting higher acuity.
In addition, Bedside PEWS was associated with a reduction in AIs related to recognition of clinical deterioration, suggesting a safer culture and improved inter-professional communication.