Which Children Deteriorate Following Inter-Facility Transport: A Retrospective Look at Patient Disposition Outcomes

Cecil, Cara; Harris, Z. Leah; Macy, Michelle L.; Newmyer, Robert E.

doi:10.1542/peds.147.3_meetingabstract.1013-a

Cited by 1 publication

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“…Other authors have reported higher incidences of nighttime escalation of care, with worsening respiratory status as the leading cause. 19,20 We hypothesized that the predominance of rapid escalations at night might be due to reduced staffing, including fewer attending physicians compared to the daytime. A previous qualitative study also cited differences in senior physician staffing and workload variability as factors impacting the timeliness of escalation of care.…”

Section: Discussionmentioning

confidence: 99%

Arriving Safely: Decreasing Rapid Escalations in Care for Incoming Transported Pediatric Patients

Zheng

Gibson

Jeong

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Accurate inpatient placement at the level of care needed for incoming transported patients can present challenges that may result in a rapid escalation in care following admission to the general inpatient unit. The Pediatric Early Warning System (PEWS) score is useful for early recognition of clinical deterioration. Therefore, we aimed to reduce rapid escalations in care for incoming transported patients via the implementation of an escalation algorithm with a goal of 80% PEWS score completion rate during transport within 6 months. Methods: We created an escalation algorithm utilizing PEWS scores and direct lines of communication between emergency medical technicians and receiving physicians. Audit and feedback increased the adoption of the process. We defined rapid escalations as transfer to a higher level of care within 6 hours of admission. Results: PEWS score completion increased from a mean of 48% to 70%. This result varied by emergency medical technician crew level of care. Eleven percent (n = 114) of PEWS scores required physician notification, 20% (n = 23) of which resulted in interventions en route. There were no differences in rapid escalation rates over time, but it remained low at <2% of all incoming transported patients. Some crew members report improved communication with hospital providers and feel more empowered to speak up when a patient’s assessment is not as expected following algorithm implementation. Conclusions: This project improved PEWS score completion and maintained a low rate of rapid escalations of care among incoming transfers.

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Section: Discussionmentioning

confidence: 99%