Implementation Study of a 5-component Pediatric Early Warning System (PEWS) in an Emergency Department in British Columbia, Canada, to inform provincial scale up

• DOI: 10.21203/rs.2.12228/v2
• Publication Date: 2019-10-24T16:59:40Z
• Authors: Theresa A McElroy; Erik N. Swartz; Kasra Hassani; Sina Waibel; Yasmin Tuff; Catherine Marshall; Richard Chan; David Wensley; Maureen O'Donnell
• Keywords: Triage; Situation Awareness

Abstract Background: The rapid identification of deterioration in the pediatric population is complex, particularly emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition clinical and provide a structured process for reassessment escalation care. objective study was to evaluate implementation fidelity, effectiveness, utility 5-component PEWS implemented ED an urban public general hospital British Columbia, Canada, guide provincial scale up. Methods: We used before-and-after design (pediatric assessment flowsheet, score, situational awareness, aid, communication framework). Sources data included patient charts, surveys direct care staff, key-informant interviews. Data were analyzed using mixed-methods approaches. Results: majority charts had documented scores at triage (80%) first bedside (81.2%), indicating that intervention with high fidelity. effective increasing vital signs documentation, both beside (84% increase) throughout stay (>100% increase), improving staff’s self-perceived knowledge confidence providing care, self-reported between staff. Satisfaction levels scoring system, lesser extent awareness tool framework. Reasons dissatisfaction increased paperwork incidence false-positives. Overall, providers indicated system completing score alongside Canadian Triage Acuity Scale (CTAS) added value ED. Results also suggest aligned current practice Conclusion: Our shows high-fidelity feasible. show multi-component can be well-accepted by lessons learned from this pilot are being up settings across province Columbia.