O059 / #669: Model for Regional Collaboration in Quality Improvement: Implementation of a Pediatric Early Warning System in 17 Pediatric Oncology Centers in Latin America and the Caribbean

Agulnik, Asya; Garza, Mannie; Gonzalez-Ruiz, Alejandra; Carrillo, Angela K.; Conde, Tania; Soberanis, D.; Rivera, Joshua O.; Martinez, A.; Villanueva, E. Pelayo; Alfonso, Yvania; Álvarez, Salvador; Barragán, Mélany; Calderón, Perla; Chavez, Miguel; Fernandez, Gallastegui S.; Fing, E.; Huitz, T.; Juárez, Sol; Miller, Krystin N.; Risco, R.; Morales, Ricardo Aldo Lama; Negrín, O.; Osuna, Antonio; Pineda, Elizabeth; Rodríguez‐Galindo, Carlos

doi:10.1097/01.pcc.0000738340.70592.e2

Cited by 4 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A centre is considered to have completed PEWS implementation when they achieved an error rate, as indicated by incorrect calculation of PEWS or algorithm use, of less than 15% for at least 2 months. 13 …”

Section: Methodsmentioning

confidence: 99%

“…In the first 3 years of the programme, we successfully supported PEWS implementation in 37 hospitals of varying resources. 13 Of these, 29 centres from 14 countries completed implementation prior to June 2020, when this study was conducted (see figure 1 ). These centres represent diverse hospital organisation, including paediatric multidisciplinary, dedicated oncology and general (adult and paediatric) hospitals with private, public and mixed (public–private) funding structures, including hospitals with or without dedicated paediatric oncology units.…”

Section: Methodsmentioning

confidence: 99%

“… 6 12 Currently, Proyecto EVAT has 60 centres in 19 countries; to date, 37 have successfully implemented PEWS. 13 Despite the potential benefit of PEWS over time, the long-term sustainability of PEWS is not yet established.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals

et al. 2021

View full text Add to dashboard Cite

BackgroundPaediatric Early Warning Systems (PEWSs) improve identification of deterioration, however, their sustainability has not been studied. Sustainability is critical to maximise impact of interventions like PEWS, particularly in low-resource settings. This study establishes the reliability and validity of a Spanish-language Clinical Sustainability Assessment Tool (CSAT) to assess clinical capacity to sustain interventions in resource-limited hospitals.MethodsParticipants included PEWS implementation leadership teams of 29 paediatric cancer centres in Latin America involved in a collaborative to implement PEWS. The CSAT, a sustainability assessment tool validated in high-resource settings, was translated into Spanish and distributed to participants as an anonymous electronic survey. Psychometric, confirmatory factor analysis (CFA), and multivariate analyses were preformed to assess reliability, structure and initial validity. Focus groups were conducted after participants reviewed CSAT reports to assess their interpretation and utility.ResultsThe CSAT survey achieved an 80% response rate (n=169) with a mean score of 4.4 (of 5; 3.8–4.8 among centres). The CSAT had good reliability with an average internal consistency of 0.77 (95% CI 0.71 to 0.81); and CFAs supported the seven-domain structure. CSAT results were associated with respondents’ perceptions of the evidence for PEWS, its implementation and use in their centre, and their assessment of the hospital culture and implementation climate. The mean CSAT score was higher among respondents at centres with longer time using PEWS (p<0.001). Focus group participants noted the CSAT report helped assess their centre’s clinical capacity to sustain PEWS and provided constructive feedback for improvement.ConclusionsWe present information supporting the reliability and validity of the CSAT tool, the first Spanish-language instrument to assess clinical capacity to sustain evidence-based interventions in hospitals of variable resource levels. This assessment demonstrates a high capacity to sustain PEWS in these resource-limited centres with improvement over time from PEWS implementation.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Although all hospitals follow the same process, centers have required variable time (range, 3-12 months) to achieve high-quality PEWS use and complete PEWS implementation. 31 This study was approved by the institutional review board of St Jude as an exempt, minimal risk study. Additional approvals were obtained by participating centers as needed.…”

Section: Escala De Valoración De Alerta Tempranamentioning

confidence: 99%

Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Pediatric early warning systems (PEWS) aid with early identification of clinical deterioration and improve outcomes in children with cancer hospitalized in resource-limited settings; however, there may be barriers to implementation. OBJECTIVE To evaluate stakeholder-reported barriers and enablers to PEWS implementation in resource-limited hospitals. DESIGN, SETTING, AND PARTICIPANTSIn this qualitative study, semistructured stakeholder interviews were conducted at 5 resource-limited pediatric oncology centers in 4 countries in Latin America. Hospitals participating in a multicenter collaborative to implement PEWS were purposefully sampled based on time required for implementation (fast vs slow), and stakeholders interviewed included physicians, nurses, and administrators, involved in PEWS implementation. An interview guide was developed using the Consolidated Framework for Implementation Research (CFIR).Interviews were conducted virtually in Spanish, audiorecorded, and professionally transcribed and translated into English. A codebook was developed a priori using the CFIR and supplemented with codes inductively derived from transcript review. Two coders independently analyzed all transcripts, achieving a κ of 0.8 to 0.9. The study was conducted from June 1 to August 31, 2020. MAIN OUTCOMES AND MEASURES Thematic analysis was conducted based on CFIR domains(inner setting, characteristics of individuals, outer setting, intervention characteristics, and implementation process) to identify barriers and enablers to PEWS implementation. RESULTSSeventy-one staff involved in PEWS implementation were interviewed, including 32 physicians (45%), 32 nurses (45%), and 7 administrators (10%). Of these, 50 were women (70%).Components of the 5 CFIR domains were mentioned by participants as barriers and enablers to PEWS implementation at both fast-and slow-implementing centers. Participants emphasized barriers at the level of the clinical staff, hospital, external factors, and PEWS intervention. These barriers included staff resistance to change, inadequate resources, components of health systems, and the perceived origin and complexity of PEWS. At all centers, most barriers were successfully converted to enablers during the implementation process through targeted strategies, such as early stakeholder engagement and adaptation, including adapting PEWS to better fit the local context and changing the hospital setting to support ongoing use of PEWS. CONCLUSIONS AND RELEVANCETo date, this is the first multicenter, multinational study describing barriers and enablers to PEWS implementation in resource-limited settings. Findings suggest that many barriers are not immutable and can be converted to enablers during the (continued) Key Points Question What barriers and enablers to pediatric early warning systems (PEWS) implementation in resource-limited hospitals are reported by health care professionals? Findings In this qualitative study including 5 resource-limited pediatric oncology centers in 4 countries in Latin America, ma...

show abstract

“…[32][33][34] To address this practice gap, in 2017, St Jude Children's Research Hospital (St Jude) partnered with pediatric oncology centers in Latin America to initiate Proyecto Escala de Valoracion de Alerta Temprana (Proyecto EVAT), a multicenter collaborative to improve the outcomes for children with cancer who experience deterioration through the implementation of PEWS. 4,35 Proyecto EVAT has supported PEWS implementation in pediatric oncology hospitals of various resource levels, 36 with preliminary results from individual centers showing improvement in patient outcomes. 32,[37][38][39][40] The experience of Proyecto EVAT represents a successful strategy for regional adoption and scale-up of an evidence-based practice (PEWS) in real-world settings.…”

Section: Introductionmentioning

confidence: 99%

Model for regional collaboration: Successful strategy to implement a pediatric early warning system in 36 pediatric oncology centers in Latin America

Agulnik

Ruiz

Muniz-Talavera

et al. 2022

Cancer

View full text Add to dashboard Cite

BACKGROUND: Pediatric early warning systems (PEWS) aid in the early identification of deterioration in hospitalized children with cancer; however, they are under-used in resource-limited settings. The authors use the knowledge-to-action framework to describe the implementation strategy for Proyecto Escala de Valoracion de Alerta Temprana (EVAT), a multicenter quality-improvement collaborative, to scale-up PEWS in pediatric oncology centers in Latin America. METHODS: Proyecto EVAT mentored participating centers through an adaptable implementation strategy to: (1) monitor clinical deterioration in children with cancer, (2) contextually adapt PEWS, (3) assess barriers to using PEWS, (4) pilot and implement PEWS, (5) monitor the use of PEWS, (6) evaluate outcomes, and (7) sustain PEWS. The implementation outcomes assessed included the quality of PEWS use, the time required for implementation, and global program impact. RESULTS: From April 2017 to October 2021, 36 diverse Proyecto EVAT hospitals from 13 countries in Latin America collectively managing more than 4100 annual new pediatric cancer diagnoses successfully implemented PEWS. The time to complete all program phases varied among centers, averaging 7 months (range, 3-13 months) from PEWS pilot to implementation completion. All centers ultimately implemented PEWS and maintained high-quality PEWS use for up to 18 months after implementation. Across the 36 centers, more than 11,100 clinicians were trained in PEWS, and more than 41,000 pediatric hospital admissions had PEWS used in their care. CONCLUSIONS: Evidence-based interventions like PEWS can be successfully scaled-up regionally basis using a systematic approach that includes a collaborative network, an adaptable implementation strategy, and regional mentorship. Lessons learned can guide future programs to promote the widespread adoption of effective interventions and reduce global disparities in childhood cancer outcomes. Cancer 2022;128:4004-4016.

show abstract

O059 / #669: Model for Regional Collaboration in Quality Improvement: Implementation of a Pediatric Early Warning System in 17 Pediatric Oncology Centers in Latin America and the Caribbean

Cited by 4 publications

References 0 publications

Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals

Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals

Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings

Model for regional collaboration: Successful strategy to implement a pediatric early warning system in 36 pediatric oncology centers in Latin America

Contact Info

Product

Resources

About