Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients

Parshuram, Christopher S.; Dryden-Palmer, Karen; Farrell, Catherine; Gottesman, Ronald; Gray, Martin; Hutchison, James S.; Helfaer, Mark A.; Hunt, Elizabeth A.; Joffe, Ari R.; Lacroix, Jacques; Moga, Michael Alice; Nadkarni, Vinay; Ninis, Nelly; Parkin, Patricia C.; Wensley, David; Willan, Andrew R.; Tomlinson, George

doi:10.1001/jama.2018.0948

Cited by 174 publications

(205 citation statements)

References 35 publications

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“…A variety of PEWS tools have been described, and there is conflicting evidence regarding the impact of PEWS in high‐resource settings. Implementation of PEWS has been shown to reduce rates of cardiac and respiratory arrests outside of the PICU, unplanned PICU transfers, and the severity of illness at the time of PICU transfer as well as improve PICU use; however, a recent study failed to demonstrate an impact on hospital mortaliy . Although to our knowledge there are limited data regarding the impact of PEWS in resource‐limited settings, PEWS have been shown to reduce hospital mortality in settings with higher baseline mortality rates, as observed in hospitals with resource limitations or in high‐risk patient populations.…”

Section: Introductionmentioning

confidence: 99%

Cost‐benefit analysis of implementing a pediatric early warning system at a pediatric oncology hospital in a low‐middle income country

Agulnik

Antillón‐Klussmann

Vásquez³

et al. 2019

Cancer

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Background Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in low‐income and middle‐income countries (LMICs). Pediatric early warning systems (PEWS) assist with the early identification of deterioration. To the authors' knowledge, no studies to date have evaluated the cost‐benefit of PEWS in LMICs. Methods A PEWS was implemented at the National Pediatric Oncology Unit (Unidad Nacional de Oncologia Pediatrica [UNOP]), a pediatric oncology hospital in Guatemala, resulting in a reduction in unplanned pediatric intensive care unit (PICU) transfers. Variable costs of maintaining the PICU and hospital floor were calculated for the year prior to and after the implementation of PEWS using administrative data. PEWS implementation costs were tabulated. The number of PICU inpatient days averted due to reduced unplanned PICU transfers after implementation was calculated, adjusting for changes in hospital inpatient days. Savings per inpatient day from unplanned PICU transfers were calculated. All costs were adjusted for inflation. Results There were 457 fewer PICU inpatient days due to unplanned transfers noted the year after implementation of PEWS, adjusting for changes in hospital volume. The variable costs of an unplanned PICU transfer versus a bed on the hospital floor was $806 per day. The total cost of implementing PEWS at UNOP was $13,644 ($7 per admission). Through reductions in variable PICU costs, UNOP saved a net $173 per admission ($354,514 annual net savings) after implementation of PEWS. The cost savings were sustained in a series of more conservative 1‐way sensitivity analyses. Conclusions Implementation of PEWS at UNOP resulted in an incremental savings due to a reduction in the number of unplanned PICU transfers. The results of the current study demonstrate that hospital investment in PEWS can improve the quality of pediatric cancer care, optimize PICU use, and reduce costs.

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Section: Introductionmentioning

confidence: 99%

Cost‐benefit analysis of implementing a pediatric early warning system at a pediatric oncology hospital in a low‐middle income country

Agulnik

Antillón‐Klussmann

Vásquez³

et al. 2019

Cancer

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“…This year marks the publication of the first prospective multicentre randomised controlled trial of PEWS 10. The Bedside PEWS are notable for the rigour of development and prior validation in differing populations 11 12.…”

Section: Where Are They Used and How Do They Perform?mentioning

confidence: 99%

Early warning scores in paediatrics: an overview

Chapman

Maconochie

2018

Arch Dis Child

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Paediatric Early Warning Scores (PEWS)are used in hospitalised patients to detect physiological deterioration and is being used increasingly throughout healthcare systems with a limited evidence based. There are two versions in general use that can lead to a clinical response, either by triggering an action or by reaching a ‘threshold’ when graduated responses may occur depending on the value of the score. Most evidence has come from research based on paediatric inpatients in specialist children’s hospitals, although the range of research is expanding, taking into account other clinical areas such as paediatric intensive care unit, emergency department and the prehospital setting. Currrently, it is uncertain whether a unified system does deliver benefits in terms of outcomes or financial savings, but it may inform and improve patient communication. PEWS may be an additional tool in context of a patient’s specific condition, and future work will include its validation for different conditions, different clinical settings, patient populations and organisational structure. The incorporation of PEWS within the electronic health records may form a keystone of the safe system framework and allow the development of consistent PEWS system to standardise practice.

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“…Paediatric early warning scores (PEWS)-based assessment is thought to reduce the variability in this process. The EPOCH cluster randomised clinical trial compared the introduction of the 'bedside PEWS' to usual care in hospitalised children [10]. This large and impressive study showed that 'bedside PEWS' was not associated with a reduction in mortality.…”

Section: Paediatric Early Warning Scores (Pews)mentioning

confidence: 99%