G16 The Paediatric Observation Priority Score (POPS): a more accurate predictor of admission risk from the Emergency Department than the Manchester Children's Early Warning System (ManChEWS)

<div class="WordSection1">Objective: Early warning system (EWS) is a physiological scoring to observe the patient’s condition not only in hospital wards but also in Emergency Department (ED). At an overcrowded ER that have slow of patient flow, EWS is use as an early detection of patient’s deterioration by observing the vital signs. The purpose of this study was to identify the relationship between nurses’ knowledge of initial assessment and the application of EWS at emergency department.Methods: This was a quantitative study that used descriptive correlative with cross-sectional design toward 70 emergency nurses.Results: The result showed there was a relationship between nurses’ knowledge of initial assessment and the application of early warning system at emergency room (p=0 .001)Conclusion: The higher the level of nurses’ knowledge, their behavior is better. It is recommended to maintain the use of EWS in ED that already good through training regularly (re-certification). <div>Keywords: Early warning system; emergency department; initial assessment; nurses’ knowledge.</div></div>

Download Full-text

Implementation Study of a 5-component Pediatric Early Warning System (PEWS) in an Emergency Department in British Columbia, Canada, to inform provincial scale up

10.21203/rs.2.12228/v1 ◽

2019 ◽

Author(s):

Theresa A McElroy ◽

Erik N. Swartz ◽

Kasra Hassani ◽

Sina Waibel ◽

Yasmin Tuff ◽

...

Keyword(s):

Emergency Department ◽

Early Warning ◽

Early Warning System ◽

Situational Awareness ◽

Scale Up ◽

Warning System ◽

Implementation Fidelity ◽

Pediatric Care ◽

Communication Framework ◽

Provincial Scale

Abstract Background: The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, to guide provincial scale up. Methods: We used a before-and-after design to evaluate the implementation fidelity, effectiveness and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid and communication framework). Sources of data included patient charts, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches. Results: The majority of charts had documented PEWS scores at triage (80%) and first bedside assessment (81.2%) indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (>100% increase), in improving staff’s self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of the PEWS system and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED.

Download Full-text

Association between emergency department chief complaint and adverse hospitalization outcomes: A simple early warning system?

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2020.07.040 ◽

2020 ◽

Author(s):

Kito Lord ◽

Craig Rothenberg ◽

Vivek Parwani ◽

Emily Finn ◽

Aamer Khan ◽

...

Keyword(s):

Emergency Department ◽

Early Warning ◽

Early Warning System ◽

Warning System ◽

Chief Complaint

Download Full-text

The use of Early Warning System Scores in Pre-Hospital and Emergency Department Settings to Predict Clinical Deterioration: s Systematic Review and Meta-Analysis

10.21203/rs.3.rs-629669/v1 ◽

2021 ◽

Author(s):

Gigi Guan ◽

Crystal Man Ying Lee ◽

Stephen Begg ◽

Angela Crombie ◽

George Mnatzaganian

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Publication Bias ◽

Early Warning ◽

Early Warning System ◽

Meta Analysis ◽

Hospital Setting ◽

Warning System ◽

Clinical Deterioration ◽

Early Warning Score

Abstract Background: It is unclear which Early Warning System (EWS) score best predicts in-hospital deterioration when applied in the emergency department (ED) or pre-hospital setting. Methods: This systematic review and meta-analysis assessed the predictive abilities of five commonly used EWS scores: National Early Warning Score (NEWS) and its updated version NEWS2, Modified Early Warning Score (MEWS), Rapid Acute Physiological Score (RAPS) and Cardiac Arrest Risk Triage (CART). Outcomes of interest included admission to ICU, up-to-≥3-day and 30-day mortality. Pooled estimates were calculated using DerSimonian and Laird random-effects models, constructed by type of EWS score, cut-off points, outcomes, and study setting. Risk of bias was assessed using the Newcastle-Ottawa Scale. Meta-regressions investigated between study heterogeneity. Funnel plots tested for publication bias. Results: A total of 11,565 articles was identified, of which 15 were included. Eight and seven articles conducted in the ED and pre-hospital settings, respectively. In the ED, MEWS and NEWS at cut-off points of 3, 4, or 6 had similar pooled diagnostic odds ratios (DOR) to predict 30-day mortality, ranging from 4.05 (Confidence Interval (CI) 2.35–6.99) to 6.48 (95% CI 1.83–22.89), p = 0.757. The ability of MEWS (cut-off point ≥ 3) to predict ICU admission had a similar pooled DOR of 5.54 (95% CI 2.02–15.21). In the pre-hospital setting, EWS scores failed to predict 30-day mortality. Using high cut-off points of 5, 7, or 9, their predictability improved when assessing up-to-≥3-day mortality with DOR ranging from 11.60 (95%, CI 9.75–13.88) to 20.37 (95% CI 13.16–31.52).Publication bias was not detected. Participants’ age explained 92% of between-study variance. Conclusion: EWS scores’ predictability of clinical deterioration improves when applied on patient populations that are already in the ED or hospital. The high thresholds used and the scores’ failure to predict 30-day mortality make them less suited for use in the pre-hospital setting.

Download Full-text

An early warning system for emerging drugs of concern in the emergency department: Protocol for the Western Australian Illicit Substance Evaluation (WISE) study

Emergency Medicine Australasia ◽

10.1111/1742-6723.13185 ◽

2018 ◽

Vol 31 (3) ◽

pp. 411-416 ◽

Cited By ~ 3

Author(s):

David McCutcheon ◽

Mohan Raghavan ◽

Jessamine Soderstrom ◽

Francois Oosthuizen ◽

Bianca Douglas ◽

...

Keyword(s):

Emergency Department ◽

Early Warning ◽

Early Warning System ◽

Warning System ◽

Illicit Substance ◽

Western Australian

Download Full-text

The implementation of a pediatric early warning system in the Sidra Pediatric Emergency Department, Qatar

Journal of Emergency Medicine Trauma and Acute Care ◽

10.5339/jemtac.2021.qhc.23 ◽

2021 ◽

Vol 2021 (2) ◽

Author(s):

Sheik Abdul Razak ◽

Lisa Goldsworthy ◽

Carmel Cullen ◽

Sudhakar Adusumilli ◽

Khalid Al Ansari ◽

...

Keyword(s):

Emergency Department ◽

Patient Care ◽

Early Warning ◽

Early Warning System ◽

Situational Awareness ◽

Vital Signs ◽

Warning System ◽

Survey Tool ◽

Nursing Team ◽

System Assessment

Background: Establishing a paediatric early warning system in a paediatric Emergency Department (ED) is a complex process and more so with the COVID-19 pandemic. PUMA (PEWS Utilisation & Morality Avoidance) is a qualitative system assessment survey tool which assesses the strengths and weaknesses of the patient care safety processes and systems within a department. This model draws together evidence from two theoretically informed systematic reviews. Methods: The Sidra Medicine ED Quality group surveyed online 200 staff from the department of physicians/nursing team focussing on processes of monitoring patients and documentation, communication amongst the team and with parents, staff empowerment, situational awareness, escalation processes and response to the deteriorating child in the three broad domains of Detect, Prepare, and Act, with a further seven smaller domains (monitor, record, interpret, review, prepare, escalate, and evaluate). Survey analysis enabled to review current practice, identify areas that are working well and areas for improvement. Results and implications: The online survey helped achieve a 85% return rate and identify seven areas for improvement in the system. The spider diagram illustrates the areas of strength and weakness in the seven domains with respect to Detect, Prepare, and Act. We collaborated with the Cerner team, created an automatic documentation of vital signs from triage and treatment areas to the patient’s Electronic Medical Record by associating patient’s cardiac monitors to reduce manual errors and for the timely monitoring of vital signs. A one-day “Back to Basics Training” refresher course for the nursing team was conducted. A senior nurse, as a watcher in the triage and treatment area, identified children at high risk of deterioration. A Pediatric ED Situational Awareness Tool (PEDSAT) was developed locally and is in trial to help manage sick children effectively. Conclusion: PUMA, a novel system assessment tool, empowered our ED to tailor a quality program with an aim to deliver effective and efficient patient care.

Download Full-text