Implementation of Bedside Pediatric Early Warning Systems (PEWS)

Implementation of Bedside PEWS at Credit Valley Hospital

Timely identification, referral and treatment of children who are clinically deteriorating while admitted to hospital wards is a fundamental element of inpatient care. In community hospitals, advantages including greater continuity of inpatient-outpatient care, improved geographic access for families, and lower healthcare system costs, may be undermined if children with evolving critical illness are not recognized and transferred in a timely manner. The Bedside Paediatric Early Warning System (Bedside PEWS) is a system of care designed to augment existing expertise and to provide a safety net for children who are clinically deteriorating while admitted to hospital wards. The Bedside PEWS is comprised of 4 components; [1] an expert derived, multi-centre validated severity of illness score, [2] an inter-professionally developed documentation record into which the severity of illness score is embedded, [3] a series of score-matched care recommendations based on the opinions of over 280 paediatric health care professionals, and [4] an educator-developed education-implementation program.

Study Overview

• Status: Completed
• Conditions: Clinically Deteriorating Paediatric Patients
• Intervention / Treatment: Other: Bedside Paediatric Early Warning System (Bedside PEWS)

Detailed Description

We will be performing a prospective observational study of care outcomes, physician workload and frontline staff perceptions before and after the implementation of Bedside PEWS in a community paediatric hospital. We plan to evaluate the outcomes of patients who were admitted to the 22-bed paediatric inpatient unit and were less than 18 years of age at hospital admission, and the healthcare professionals caring for them during their inpatient stay.

• Study Type: Observational
• Enrollment (Actual): 200

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada
      • The Hospital for Sick Children

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 1 day to 18 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

Patients admitted to the 22-bed paediatric inpatient unit and were less than 18 years of age at hospital admission

Description

Inclusion Criteria:

• All patients admitted to the paediatric inpatient unit at Credit Valley Hospital from June 2008-December 2008

Exclusion Criteria:

• Patients over 18 years of age

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Crossover
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

PEWS System of Care

Other: Bedside Paediatric Early Warning System (Bedside PEWS); The Bedside PEWS is comprised of 4 components; [1] an expert derived, multi-centre validated severity of illness score, [2] an inter-professionally developed documentation record into which the severity of illness score is embedded, [3] a series of score-matched care recommendations based on the opinions of over 280 paediatric health care professionals, and [4] an educator-developed education-implementation program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Significant clinical deterioration events	-3 months, +2months, and+5months after implementation

Secondary Outcome Measures

Outcome Measure	Time Frame
'stat' calls to the paediatrician	3 months before and 5 months after implementation
'stat' calls to the respiratory therapist	3 months before and 5 months after implementation
immediate calls to treat near or actual cardiopulmonary arrest - 'code-blue'	3 months before and 5 months after implementation

Collaborators and Investigators

• Sponsor: The Hospital for Sick Children
• Collaborators: Ontario Ministry of Health and Long Term Care
• Investigators: Principal Investigator: Christopher Parshuram, MD, The Hospital for Sick Children

Study record dates

Study Major Dates

• Study Start: June 1, 2008
• Primary Completion (Actual): December 1, 2008
• Study Completion (Actual): December 1, 2008

Study Registration Dates

• First Submitted: August 17, 2009
• First Submitted That Met QC Criteria: August 18, 2009
• First Posted (Estimate): August 19, 2009

Study Record Updates

• Last Update Posted (Estimate): June 1, 2015
• Last Update Submitted That Met QC Criteria: May 28, 2015
• Last Verified: May 1, 2015

More Information

Terms related to this study

• Keywords: Bedside Pews; Credit Valley Hospital; The Bedside Paediatric Early Warning System; clinically deteriorating
• Other Study ID Numbers: 1000009778