Implementation of Bedside Pediatric Early Warning Systems (PEWS)

Study Overview
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Brief Summary
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Timely identification, referral and treatment of children who are clinically deteriorating while admitted to hospital wards is a fundamental element of inpatient care. In community hospitals, advantages including greater continuity of inpatient-outpatient care, improved geographic access for families, and lower healthcare system costs, may be undermined if children with evolving critical illness are not recognized and transferred in a timely manner. The Bedside Paediatric Early Warning System (Bedside PEWS) is a system of care designed to augment existing expertise and to provide a safety net for children who are clinically deteriorating while admitted to hospital wards. The Bedside PEWS is comprised of 4 components; [1] an expert derived, multi-centre validated severity of illness score, [2] an inter-professionally developed documentation record into which the severity of illness score is embedded, [3] a series of score-matched care recommendations based on the opinions of over 280 paediatric health care professionals, and [4] an educator-developed education-implementation program.

Detailed Description
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We will be performing a prospective observational study of care outcomes, physician workload and frontline staff perceptions before and after the implementation of Bedside PEWS in a community paediatric hospital. We plan to evaluate the outcomes of patients who were admitted to the 22-bed paediatric inpatient unit and were less than 18 years of age at hospital admission, and the healthcare professionals caring for them during their inpatient stay.

Official Title
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Implementation of Bedside PEWS at Credit Valley Hospital

Conditions
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Clinically Deteriorating Paediatric Patients

Intervention / Treatment
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* Other: Bedside Paediatric Early Warning System (Bedside PEWS)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients admitted to the paediatric inpatient unit at Credit Valley Hospital from June 2008-December 2008 Exclusion Criteria: Patients over 18 years of age

Ages Eligible for Study
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Minimum Age: 1 Day
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| PEWS System of Care<br> | Other: Bedside Paediatric Early Warning System (Bedside PEWS)<br>* The Bedside PEWS is comprised of 4 components; [1] an expert derived, multi-centre validated severity of illness score, [2] an inter-professionally developed documentation record into which the severity of illness score is embedded, [3] a series of score-matched care recommendations based on the opinions of over 280 paediatric health care professionals, and [4] an educator-developed education-implementation program.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Significant clinical deterioration events |  | -3 months, +2months, and+5months after implementation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 'stat' calls to the paediatrician |  | 3 months before and 5 months after implementation | 
| 'stat' calls to the respiratory therapist |  | 3 months before and 5 months after implementation | 
| immediate calls to treat near or actual cardiopulmonary arrest - 'code-blue' |  | 3 months before and 5 months after implementation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bedside Pews, Credit Valley Hospital, The Bedside Paediatric Early Warning System, clinically deteriorating