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Improved outcomes after successful implementation of a pediatric early warning system (PEWS) in a resource‐limited pediatric oncology hospital

2017; Wiley; Volume: 123; Issue: 15 Linguagem: Inglês

10.1002/cncr.30664

1097-0142

Asya Agulnik, Lupe Nataly Mora Robles, Peter W. Forbes, Doris Judith Soberanis Vasquez, Ricardo Mack, Federico Antillón‐Klussmann, Monica E. Kleinman, Carlos Rodríguez‐Galindo,

Neonatal Respiratory Health Research

BACKGROUND Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in resource‐limited settings. Pediatric early warning systems (PEWS) aid in the early identification of clinical deterioration; however, there are limited data regarding their feasibility or impact in low‐resource settings. This study describes the successful implementation of PEWS at the Unidad Nacional de Oncología Pediátrica (UNOP), a pediatric oncology hospital in Guatemala, resulting in improved inpatient outcomes. METHODS A modified PEWS was implemented at UNOP with systems to track errors, transfers to a higher level of care, and high scores. A retrospective cohort study was used to evaluate clinical deterioration events in the year before and after PEWS implementation. RESULTS After PEWS implementation at UNOP, there was 100% compliance with PEWS documentation and an error rate of <10%. Implementation resulted in 5 high PEWS per week, with 30% of patients transferring to a higher level of care. Among patients requiring transfer to the pediatric intensive care unit (PICU), 93% had an abnormal PEWS before transfer. The rate of clinical deterioration events decreased after PEWS implementation (9.3 vs 6.5 per 1000‐hospitalpatient‐days, p = .003). Despite an 18% increase in total hospital patient‐days, PICU utilization for inpatient transfers decreased from 1376 to 1088 PICU patient‐days per year (21% decrease; P <.001). CONCLUSIONS This study describes the successful implementation of PEWS in a pediatric oncology hospital in Guatemala, resulting in decreased inpatient clinical deterioration events and PICU utilization. This work demonstrates that PEWS is a feasible and effective quality improvement measure to improve hospital care for children with cancer in hospitals with limited resources. Cancer 2017;123:2965–74. © 2017 American Cancer Society .