Implementation of the Pediatric Early Warning Scoring System on a Pediatric Hematology/Oncology Unit

Demmel, Kathleen Marie; Williams, Lucinda; Flesch, Laura

doi:10.1177/1043454209358410

Cited by 32 publications

(37 citation statements)

References 30 publications

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“…Overall, the current study data thus highlighted that the resources required to improve the provision of quality health services in clinical settings in LMICs can be offset by savings. Although there is literature regarding the use of PEWS to improve the monitoring of pediatric oncology patients in high-resource settings, 24 and various PEWS have been validated to predict clinical deterioration in hospitalized children with cancer in these settings, 25,26 to our knowledge cost-benefit analyses for PEWS in this patient population are sparse. The observed cost benefit from implementation of PEWS leading to a reduction in PICU use for clinical deterioration is consistent with the, albeit limited, adult and pediatric literature concerning cost analyses of early warning systems in high-resource settings.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…There was one feasibility and reliability testing study, one cost-analysis exercise, one protocol and one course evaluation survey. Of the 90 included papers, 45 focused on PEW detection systems, 2 3 6 7 10 14-53 29 examined PEW response mechanisms 8 54-81 and 16 reported on PEW implementation strategies [82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] (see online supplementary appendix 2 for a summary of these studies including the level of evidence and rationale for judgement).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

et al. 2017

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ObjectiveTo systematically review the available evidence on paediatric early warning systems (PEWS) for use in acute paediatric healthcare settings for the detection of, and timely response to, clinical deterioration in children.MethodThe electronic databases PubMed, MEDLINE, CINAHL, EMBASE and Cochrane were searched systematically from inception up to August 2016. Eligible studies had to refer to PEWS, inclusive of rapid response systems and teams. Outcomes had to be specific to the identification of and/or response to clinical deterioration in children (including neonates) in paediatric hospital settings (including emergency departments). 2 review authors independently completed the screening and selection process, the quality appraisal of the retrieved evidence and data extraction; with a third reviewer resolving any discrepancies, as required. Results were narratively synthesised.ResultsFrom a total screening of 2742 papers, 90 papers, of varied designs, were identified as eligible for inclusion in the review. Findings revealed that PEWS are extensively used internationally in paediatric inpatient hospital settings. However, robust empirical evidence on which PEWS is most effective was limited. The studies examined did however highlight some evidence of positive directional trends in improving clinical and process-based outcomes for clinically deteriorating children. Favourable outcomes were also identified for enhanced multidisciplinary team work, communication and confidence in recognising, reporting and making decisions about child clinical deterioration.ConclusionsDespite many studies reporting on the complexity and multifaceted nature of PEWS, no evidence was sourced which examined PEWS as a complex healthcare intervention. Future research needs to investigate PEWS as a complex multifaceted sociotechnical system that is embedded in a wider safety culture influenced by many organisational and human factors. PEWS should be embraced as a part of a larger multifaceted safety framework that will develop and grow over time with strong governance and leadership, targeted training, ongoing support and continuous improvement.

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“…There are numerous published PEWS tools which vary in accuracy predicting deterioration; 3,4 some have been successfully validated in multicenter trials, 5 and across various subspecialty populations. [7][8][9] PEWS are widely used in hospitals caring for pediatric oncology patients, 10 and one score has been validated to predict unplanned PICU transfer in hospitalized oncology and hematopoietic stem cell transplant (HSCT) patients. [7][8][9] PEWS are widely used in hospitals caring for pediatric oncology patients, 10 and one score has been validated to predict unplanned PICU transfer in hospitalized oncology and hematopoietic stem cell transplant (HSCT) patients.…”

Section: Introductionmentioning

confidence: 99%

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

Agulnik

Robles²,

Forbes

et al. 2017

Cancer

139

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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.

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Implementation of the Pediatric Early Warning Scoring System on a Pediatric Hematology/Oncology Unit

Cited by 32 publications

References 30 publications

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

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

Paediatric early warning systems for detecting and responding to clinical deterioration in children: a systematic review

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

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