Pediatric Early Warning Systems (PEWS) improve provider‐family communication from the provider perspective in pediatric cancer patients experiencing clinical deterioration

Abstract

Background Communication between providers and patients' families is an integral part of clinical care. Family concern is a validated component of Pediatric Early Warning Systems (PEWS); however, little is known about the impact of PEWS on provider‐family communication. Methods Semi‐structured interviews were conducted with 83 ward and Pediatric Intensive Care Unit (PICU) providers involved in the care of patients with deterioration at two pediatric oncology hospitals of different resource levels: St. Jude Children's Research Hospital ( n = 42) in the United States and Unidad Nacional de Oncología Pediátrica (UNOP, n = 41) in Guatemala. Interviews were conducted in the participants' native language (English or Spanish), transcribed, and translated into English. Transcripts were coded by two researchers and analyzed for thematic content surrounding family communication and concern. Results All participants recognized patients' families as a valuable part of the care team, particularly during events requiring escalation of care. Perceived barriers to communication included limited time spent at the bedside, and, at UNOP, language and literacy challenges which occasionally limited providers' ability to assess family concern and involve families in patient care. Despite these barriers, providers perceived PEWS improved communication by facilitating more interaction with families, allowing for relationship‐building, anticipatory guidance, and destigmatization of the PICU. PEWS assessments also allowed families to contribute to identification of deterioration. Conclusions PEWS improve the quality of communication between providers and families by providing more opportunities for interaction, building relationships, and trust. These findings further support the use of PEWS in the care of children with cancer in hospitals of all resource‐levels.

Stages of change: Strategies to promote use of a Pediatric Early Warning System in resource‐limited pediatric oncology centers

“…This score is associated with an action algorithm that guides the clinical team's response 4 . PEWS have been shown to reduce clinical deterioration events and PICU utilization, improve interdisciplinary and provider‐family communication, enhance perceptions of healthcare quality, support clinician emotions, and result in cost‐savings 4–10 . However, PEWS are rarely used in resources‐limited hospitals, in part due to challenges during implementation 3 …”

“…4 PEWS have been shown to reduce clinical deterioration events and PICU utilization, improve interdisciplinary and provider-family communication, enhance perceptions of healthcare quality, support clinician emotions, and result in cost-savings. [4][5][6][7][8][9][10] However, PEWS are rarely used in resources-limited hospitals, in part due to challenges during implementation. 3 Prior work identified stakeholder "stage of change" as integral to successful PEWS implementation.…”

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

“…Pediatric early warning systems (PEWS) are nursing‐administered bedside acuity scoring tools associated with escalation algorithms 17,18 that facilitate the early identification of clinical deterioration in hospitalized children. Whereas data from high‐resource settings report conflicting impacts of PEWS on patient outcomes, 19 the implementation of PEWS in resource‐limited hospitals has been shown to reduce CDEs, optimize intensive care unit (ICU) use, 20 improve family 21 and interdisciplinary communication, 22 reduce negative provider emotions, 23 increase perceived hospital quality of care, 24 and produce significant cost savings 25 . PEWS have been validated to identify deterioration and facilitate patient triage in both high‐resource 26,27 and resource‐limited settings 28,29 …”

“…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. The knowledge-to-action (KTA) framework 41 1 Department of Global Pediatric Medicine, St Jude Children's Research Hospital, Memphis, Tennessee, USA; 2 Casa de la Amistad, Mexico City, Mexico; 3 Pediatric Intensive Care Unit, Unidad Nacional de Oncología Pediátrica (UNOP), Guatemala City, Guatemala; 4 Pediatric Critical Care, Hospital Dr Luis Calvo Mackenna, Santiago, Chile; 5 Pediatric Hemato-oncology, Hospital St Damien, Port-Au-Prince, Haiti; 6 Pediatric Hemato-Oncology, Benemérito Hospital General con Especialidades "Juan María de Salvatierra", La Paz, Mexico; 7 Pediatric Hemato-Oncology, Hospital Nacional de Niños, San Jose, Costa Rica; 8 Pediatric Hemato-Oncology, Hospital Jose Domingo De Obaldía, Chiriqui, Panama; 9 Pediatric Critical Care, Sociedad de Lucha Contra el Cáncer (SOLCA) Guayaquil, Guayaquil, Ecuador; 10 Pediatric Hemato-Oncology, Hospital del Niño Poblano, Puebla, Mexico; 11 Pediatric Hospitalization Unit, Hospital Universitario Austral, Buenos Aires, Argentina; 12 Pediatric Hemato-Oncology, Hospital General de Celaya, Celaya, Mexico; 13 Pediatric Hemato-Oncology, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic; 14 Chief Medical Officer, Hospital de Especialidades Pediátricas, Tuxtla Gutierrez, Mexico; 15 Pediatric Hemato-Oncology, Centro Médico Nacional Siglo XXI, Mexico City, Mexico; 16 Pediatric Hemato-Oncology, Hospital Infantil de Especialidades de Chihuahua, Chihuahua, Mexico; 17 Pediatric Hemato-Oncology, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico; 18 Pediatric Hemato-Oncology, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, Mexico; 19 Pediatric Hemato-Oncology, Instituto de Seguridad Social del Estado de México y Municipos Hospital Materno Infantil, Toluca, Mexico; 20 Pediatric Hospitalization Unit., Hospital General de Tijuana, Tijuana, Mexico; 21 Pediatric Hemato-Oncology, Hospital del Niño "Jose Renan Esquivel", Panama, Panama; 22 Pediatric Critical Care, Hospital Escuela, Tegucigalpa, Honduras; 23 Pediatric Hemato-Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; 24 Pediatric Hemato-Oncology, Hospital General Agustin O'Horan, Mérida, Mexico; 25 Pediatric Hemato-Oncology, Hospital Pediátrico de Sinaloa, Culiacan, Mexico; 26 Pediatric Hemato-Oncology, Hospital Guillermo Almenara Irigoyen, Lima, Peru; 27 Pediatric...…”

Management of septic shock in children with cancer—Common challenges and research priorities

“… 12 Multiple studies have noted the effectiveness of quality improvement initiatives to promote proactive identification and management of critical illness, such as Pediatric Early Warning Systems (PEWS), to improve hospital outcomes in children with cancer. 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 Hospital and provider experience managing children with cancer are also important, with high-volume centers typically having lower PICU mortality for these patients. 18 , 29 Finally, strong interdisciplinary (oncology, intensive care, etc.)…”