1
|
Carter B, Saron H, Blake L, Eyton-Chong CK, Dee S, Evans L, Harris J, Hughes H, Jones D, Lambert C, Lane S, Mehta F, Peak M, Preston J, Siner S, Sefton G, Carrol ED. Clinical utility and acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): A prospective e-survey of parents and health professionals. PLoS One 2022; 17:e0273666. [PMID: 36107953 PMCID: PMC9477367 DOI: 10.1371/journal.pone.0273666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Paediatric early warning systems (PEWS) are a means of tracking physiological state and alerting healthcare professionals about signs of deterioration, triggering a clinical review and/or escalation of care of children. A proactive end-to-end deterioration solution (the DETECT surveillance system) with an embedded e-PEWS that included sepsis screening was introduced across a tertiary children’s hospital. One component of the implementation programme was a sub-study to determine an understanding of the DETECT e-PEWS in terms of its clinical utility and its acceptability. Aim This study aimed to examine how parents and health professionals view and engage with the DETECT e-PEWS apps, with a particular focus on its clinical utility and its acceptability. Method A prospective, closed (tick box or sliding scale) and open (text based) question, e-survey of parents (n = 137) and health professionals (n = 151) with experience of DETECT e-PEWS. Data were collected between February 2020 and February 2021. Results Quantitative data were analysed using descriptive and inferential statistics and qualitative data with generic thematic analysis. Overall, both clinical utility and acceptability (across seven constructs) were high across both stakeholder groups although some challenges to utility (e.g., sensitivity of triggers within specific patient populations) and acceptability (e.g., burden related to having to carry extra technology) were identified. Conclusion Despite the multifaceted nature of the intervention and the complexity of implementation across a hospital, the system demonstrated clinical utility and acceptability across two key groups of stakeholders: parents and health professionals.
Collapse
Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
- * E-mail:
| | - Holly Saron
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Lucy Blake
- Department of Social Sciences, University of West of England, Bristol, United Kingdom
| | - Chin-Kien Eyton-Chong
- Department of General Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Sarah Dee
- High Dependency Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Leah Evans
- High Dependency Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Jane Harris
- Faculty of Health, Public Health Institute, Liverpool John Moores University, United Kingdom
| | - Hannah Hughes
- Oncology Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Dawn Jones
- Clinical Research Division, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Caroline Lambert
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Steven Lane
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Fulya Mehta
- Department of General Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Matthew Peak
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Jennifer Preston
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Siner
- Clinical Research Division, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Gerri Sefton
- Paediatric Intensive Care Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Enitan D. Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
2
|
Chong SL, Goh MSL, Ong GYK, Acworth J, Sultana R, Yao SHW, Ng KC, Scholefield B, Aickin R, Maconochie I, Atkins D, Couto TB, Guerguerian AM, Kleinman M, Kloeck D, Nadkarni V, Nuthall G, Reis A, Rodriguez-Nunez A, Schexnayder S, Tijssen J, Van de Voorde P, Morley P. Do paediatric early warning systems reduce mortality and critical deterioration events among children? A systematic review and meta-analysis. Resusc Plus 2022; 11:100262. [PMID: 35801231 PMCID: PMC9253845 DOI: 10.1016/j.resplu.2022.100262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/02/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
Aim We conducted a systematic review and meta-analysis to answer the question: Does the implementation of Paediatric Early Warning Systems (PEWS) in the hospital setting reduce mortality, cardiopulmonary arrests, unplanned codes and critical deterioration events among children, as compared to usual care without PEWS? Methods We conducted a comprehensive search using Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Web of Science. We included studies published between January 2006 and April 2022 on children <18 years old performed in inpatient units and emergency departments, and compared patient populations with PEWS to those without PEWS. We excluded studies without a comparator, case control studies, systematic reviews, and studies published in non-English languages. We employed a random effects meta-analysis and synthesised the risk and rate ratios from individual studies. We used the Scottish Intercollegiate Guidelines Network (SIGN) to appraise the risk of bias. Results Among 911 articles screened, 15 were included for descriptive analysis. Fourteen of the 15 studies were pre- versus post-implementation studies and one was a multi-centre cluster randomised controlled trial (RCT). Among 10 studies (580,604 hospital admissions) analysed for mortality, we found an increased risk (pooled RR 1.18, 95% CI 1.01–1.38, p = 0.036) in the group without PEWS compared to the group with PEWS. The sensitivity analysis performed without the RCT (436,065 hospital admissions) showed a non-significant relationship (pooled RR 1.17, 95% CI 0.98–1.40, p = 0.087). Among four studies (168,544 hospital admissions) analysed for unplanned code events, there was an increased risk in the group without PEWS (pooled RR 1.73, 95%CI 1.01–2.96, p = 0.046) There were no differences in the rate of cardiopulmonary arrests or critical deterioration events between groups. Our findings were limited by potential confounders and imprecision among included studies. Conclusions Healthcare systems that implemented PEWS were associated with reduced mortality and code rates. We recognise that these gains vary depending on resource availability and efferent response systems. PROSPERO registration: CRD42021269579.
Collapse
|
3
|
Roland D, Powell C, Lloyd A, Trubey R, Tume L, Sefton G, Huang C, Taiyari K, Strange H, Jacob N, Thomas-Jones E, Hood K, Allen D. Paediatric early warning systems: not a simple answer to a complex question. Arch Dis Child 2022; 108:archdischild-2022-323951. [PMID: 35868852 PMCID: PMC10176370 DOI: 10.1136/archdischild-2022-323951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/09/2022] [Indexed: 11/04/2022]
Abstract
Paediatric early warning systems (PEWS) to reduce in-hospital mortality have been a laudable endeavour. Evaluation of their impact has rarely examined the internal validity of the components of PEWS in achieving desired outcomes. We highlight the assumptions made regarding the mode of action of PEWS and, as PEWS become more commonplace, this paper asks whether we really understand their function, process and outcome.
Collapse
Affiliation(s)
- Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Colin Powell
- Department of Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Amy Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Robert Trubey
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Lyvonne Tume
- School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Gerri Sefton
- Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Chao Huang
- Hull-York Medical School, University of Hull, Hull, UK
| | - Katie Taiyari
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Nina Jacob
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Davina Allen
- Centre for Trials Research, Cardiff University, Cardiff, UK
- School of Healthcare Sciences, Cardiff University Centre for Trials Research, Cardiff, Wales, UK
| |
Collapse
|
4
|
Saron H, Carter B, Siner S, Preston J, Peak M, Mehta F, Lane S, Lambert C, Jones D, Hughes H, Harris J, Evans L, Dee S, Eyton-Chong CK, Carrol ED, Sefton G. Parents' experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic pediatric early warning system (the DETECT study): A qualitative interview study. Front Pediatr 2022; 10:954738. [PMID: 36110117 PMCID: PMC9468741 DOI: 10.3389/fped.2022.954738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Failure to recognize and respond to clinical deterioration in a timely and effective manner is an urgent safety concern, driving the need for early identification systems to be embedded in the care of children in hospital. Pediatric early warning systems (PEWS) or PEW scores alert health professionals (HPs) to signs of deterioration, trigger a review and escalate care as needed. PEW scoring allows HPs to record a child's vital signs and other key data including parent concern. AIM This study aimed to explore the experiences and perceptions of parents about the acceptability of a newly implemented electronic surveillance system (the DETECT surveillance system), and factors that influenced acceptability and their awareness around signs of clinical deterioration and raising concern. METHODS Descriptive, qualitative semi-structured telephone interviews were undertaken with parents of children who had experienced a critical deterioration event (CDE) (n = 19) and parents of those who had not experienced a CDE (non-CDE parents) (n = 17). Data were collected between February 2020 and February 2021. RESULTS Qualitative data were analyzed using generic thematic analysis. Analysis revealed an overarching theme of trust as a key factor that underpinned all aspects of children's vital signs being recorded and monitored. The main themes reflect three domains of parents' trust: trust in themselves, trust in the HPs, and trust in the technology. CONCLUSION Parents' experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic pediatric early warning system (The DETECT system) were positive; they found it acceptable and welcomed the use of new technology to support the care of their child.
Collapse
Affiliation(s)
- Holly Saron
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Sarah Siner
- Clinical Research Division, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Jennifer Preston
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Matthew Peak
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Fulya Mehta
- Department of General Paediatrics, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Steven Lane
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Caroline Lambert
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.,Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Dawn Jones
- Clinical Research Division, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Hannah Hughes
- Oncology Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Jane Harris
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
| | - Leah Evans
- High Dependency Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Sarah Dee
- High Dependency Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Chin-Kien Eyton-Chong
- High Dependency Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Enitan D Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.,Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Gerri Sefton
- Paediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|