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

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.

scholarly journals Relationship between Nurses’ Knowledge of Initial Assessment and Application of Early Warning System At Emergency Department of Type A Hospital In Jakarta

2020 ◽  
Vol 4 (1) ◽  
pp. 12
Author(s):  
Sekar Dwi Purnamasari ◽  
Denissa Faradita Aryani
Keyword(s):  
Emergency Department ◽  
Early Warning ◽  
Early Warning System ◽  
Patient Flow ◽  
Vital Signs ◽  
Warning System ◽  
Initial Assessment ◽  
Emergency Nurses ◽  
Cross Sectional ◽  
Nurses Knowledge

<div class="WordSection1"><p class="AbstractContent"><strong>Objective:</strong> 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.</p><p class="AbstractContent"><strong>Methods: </strong>This was a quantitative study that used descriptive correlative with cross-sectional design toward 70 emergency nurses.</p><p class="AbstractContent"><strong>Results:</strong> The result showed there was a relationship between nurses’ knowledge of initial assessment and the application of early warning system at emergency room <em>(p</em>=0 .001)<strong></strong></p><p><strong>Conclusion: </strong>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).</p><p class="AbstractContent"><strong> </strong></p><div><p class="Keywords"><strong>Keywords: </strong>Early warning system; emergency department; initial assessment; nurses’ knowledge.</p></div></div>

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

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.

Development of a Pediatric Early Warning System Using Data-Driven Vital Signs

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 256A-256A
Author(s):  
Catherine Ross ◽  
Iliana Harrysson ◽  
Lynda Knight ◽  
Veena Goel ◽  
Sarah Poole ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Vital Signs ◽  
Warning System ◽  
Data Driven ◽  
Using Data

scholarly journals Development and validation of an early warning tool for sepsis and decompensation in children during emergency department triage

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Louis Ehwerhemuepha ◽  
Theodore Heyming ◽  
Rachel Marano ◽  
Mary Jane Piroutek ◽  
Antonio C. Arrieta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Severe Sepsis ◽  
Early Warning ◽  
Characteristic Curve ◽  
Vital Signs ◽  
Warning System ◽  
Receiver Operator Characteristic Curve ◽  
Warning Signs ◽  
Gradient Boosting ◽  
Stochastic Gradient Boosting

AbstractThis study was designed to develop and validate an early warning system for sepsis based on a predictive model of critical decompensation. Data from the electronic medical records for 537,837 visits to a pediatric Emergency Department (ED) from March 2013 to December 2019 were collected. A multiclass stochastic gradient boosting model was built to identify early warning signs associated with death, severe sepsis, non-severe sepsis, and bacteremia. Model features included triage vital signs, previous diagnoses, medications, and healthcare utilizations within 6 months of the index ED visit. There were 483 patients who had severe sepsis and/or died, 1102 had non-severe sepsis, 1103 had positive bacteremia tests, and the remaining had none of the events. The most important predictors were age, heart rate, length of stay of previous hospitalizations, temperature, systolic blood pressure, and prior sepsis. The one-versus-all area under the receiver operator characteristic curve (AUROC) were 0.979 (0.967, 0.991), 0.990 (0.985, 0.995), 0.976 (0.972, 0.981), and 0.968 (0.962, 0.974) for death, severe sepsis, non-severe sepsis, and bacteremia without sepsis respectively. The multi-class macro average AUROC and area under the precision recall curve were 0.977 and 0.316 respectively. The study findings were used to develop an automated early warning decision tool for sepsis. Implementation of this model in pediatric EDs will allow sepsis-related critical decompensation to be predicted accurately after a few seconds of triage.

scholarly journals Pemberdayaan Perawat dalam Penerapan Nurse Early Warning System untuk Memantau Kondisi Pasien di Rumah Sakit

2020 ◽  
Vol 2 (2) ◽  
pp. 135
Author(s):  
Junaedi Yunding ◽  
Masyita Haerianti ◽  
Evidamayanti Evidamayanti ◽  
Evawaty Evawaty ◽  
Indrawati Indrawati
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Emergency Services ◽  
Vital Signs ◽  
Warning System ◽  
Independent Practice ◽  
Knowledge And Skills ◽  
Detection Tool ◽  
Service Institution ◽  
Implementation Method

AbstractSevere adverse events such as cardiac arrest and death are often marked by abnormal vital signs a few hours before the event. Majene Regional General Hospital is the only hospital in the Majene Regency and is a reference center for all puskesmas in the Majene and surrounding districts. As a health service institution that organizes health services, it is closely related to the responsibility of providing emergency services. The Nurse Early Warning System (NEWS) is a development in emergency services for patients treated in hospitals, which serves as an early detection tool so that if there is a decrease in the patient's condition it can be known earlier can be handled more quickly. The purpose of this activity is to increase the knowledge and skills of nurses in the application of the nurse early warning system (NEWS) in monitoring the condition of patients in the care room. The implementation method starts from identifying the problem, delivering material about NEWS, demonstrating the assessment of the patient's condition and the nurse's independent practice in using NEWS. The evaluation results of this activity are the increase in knowledge and skills of nurses using NEWS in monitoring the condition of patients in the care room.

scholarly journals Development and evaluation of a novel Vital Signs Alert device for use in pregnancy in low-resource settings

2018 ◽  
Vol 4 (4) ◽  
pp. 192-198 ◽  
Author(s):  
Hannah L Nathan ◽  
Nicola Vousden ◽  
Elodie Lawley ◽  
Annemarie de Greeff ◽  
Natasha L Hezelgrave ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Early Warning ◽  
Early Warning System ◽  
Healthcare Providers ◽  
Vital Signs ◽  
Warning System ◽  
Evidence Based ◽  
Traffic Light ◽  
Low Resource Settings ◽  
In Pregnancy

ObjectivesHaemorrhage, hypertension, sepsis and abortion complications (often from haemorrhage or sepsis) contribute to 60% of all maternal deaths. Each is associated with vital signs (blood pressure (BP) and pulse) abnormalities, and the majority of deaths are preventable through simple and timely intervention. This paper presents the development and evaluation of the CRADLE Vital Signs Alert (VSA), an accurate, low-cost and easy-to-use device measuring BP and pulse with an integrated traffic light early warning system. The VSA was designed to be used by all cadres of healthcare providers for pregnant women in low-resource settings with the aim to prevent avoidable maternal mortality and morbidity.MethodsThe development and the mixed-methods clinical evaluation of the VSA are described.ResultsPreliminary fieldwork identified that introduction of BP devices to rural clinics improved antenatal surveillance of BP in pregnant women. The aesthetics of the integrated traffic light system were developed through iterative qualitative evaluation. The traffic lights trigger according to evidence-based vital sign thresholds in hypertension and haemodynamic compromise from haemorrhage and sepsis. The VSA can be reliably used as an auscultatory device, as well as its primary semiautomated function, and is suitable as a self-monitor used by pregnant women.ConclusionThe VSA is an accurate device incorporating an evidence-based traffic light early warning system. It is designed to ensure suitability for healthcare providers with limited training and may improve care for women in pregnancy, childbirth and in the postnatal period.

scholarly journals Implementation and adherence to the Bedside Paediatric Early Warning System (BedsidePEWS) in a pediatric tertiary care hospital

2020 ◽  
Author(s):  
Orsola Gawronski ◽  
Federico Ferro ◽  
Corrado Cecchetti ◽  
Marta Luisa Ciofi Degli Atti ◽  
Immacolata Dall'oglio ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Tertiary Care ◽  
Vital Signs ◽  
Warning System ◽  
Hospital Inpatient ◽  
Care Hospital ◽  
Clinical Records ◽  
Hospital Wards ◽  
Score Range

Abstract BackgroundClinical deterioration in children admitted to hospital wards often manifests through signs of increasing illness severity that may lead to unplanned Pediatric Intensive Care Unit admissions or cardiac arrest, if undetected. The Bedside Pediatric Early Warning System (BedsidePEWS) is a validated Canadian scoring system used at a large tertiary care children’ hospital to prevent critical illness and standardize the response to deteriorating children on the wards.MethodsA 6-month audit was performed to evaluate the use of the BedsidePEWS, escalation of patient observations, monitoring and medical reviews on the wards in 2018.Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P <0.05 considered as significant).ResultsA total of 522 Vital Signs (VS) and score calculations on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of VS and score documentation occurred <3 times per day in 33% of the observations. Adherence to the VS documentation frequency according to the hospital protocol was observed in 54% for all patients; for children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47%, P=0.006). The BedsidePEWS score was correctly calculated and documented in 84% of the observed VS documentation events. Systolic blood Pressure was recorded in 79% and Temperature in 91% of the VS recording events. Patients within a 0-2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50% of the patients in the 5-6 score range were reviewed within 4 hours and 42% of the patients with a score ≥7 within 2 hours. Transcutaneous Oxygen Saturation continuous monitoring was applied to 60% of the children at higher risk (BedsidePEWS ≥5).ConclusionsEscalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

scholarly journals Adherence to the bedside paediatric early warning system (BedsidePEWS) in a pediatric tertiary care hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Orsola Gawronski ◽  
Federico Ferro ◽  
Corrado Cecchetti ◽  
Marta Ciofi Degli Atti ◽  
Immacolata Dall’Oglio ◽  
...  
Keyword(s):  
Early Warning ◽  
Early Warning System ◽  
Tertiary Care ◽  
Vital Signs ◽  
Warning System ◽  
Hospital Inpatient ◽  
Care Hospital ◽  
Clinical Records ◽  
Hospital Wards ◽  
Score Range

Abstract Background The aim of this study is to describe the adherence to the Bedside Pediatric Early Warning System (BedsidePEWS) escalation protocol in children admitted to hospital wards in a large tertiary care children’s hospital in Italy. Methods This is a retrospective observational chart review. Data on the frequency and accuracy of BedsidePEWS score calculations, escalation of patient observations, monitoring and medical reviews were recorded. Two research nurses performed weekly visits to the hospital wards to collect data on BedsidePEWS scores, medical reviews, type of monitoring and vital signs recorded. Data were described through means or medians according to the distribution. Inferences were calculated either with Chi-square, Student’s t test or Wilcoxon-Mann–Whitney test, as appropriate (P < 0.05 considered as significant). Results A total of 522 Vital Signs (VS) and score calculations [BedsidePEWS documentation events, (DE)] on 177 patient clinical records were observed from 13 hospital inpatient wards. Frequency of BedsidePEWS DE occurred < 3 times per day in 33 % of the observations. Adherence to the BedsidePEWS documentation frequency according to the hospital protocol was observed in 54 % of all patients; in children with chronic health conditions (CHC) it was significantly lower than children admitted for acute medical conditions (47 % vs. 69 %, P = 0.006). The BedsidePEWS score was correctly calculated and documented in 84 % of the BedsidePEWS DE. Patients in a 0–2 BedsidePEWS score range were all reviewed at least once a day by a physician. Only 50 % of the patients in the 5–6 score range were reviewed within 4 h and 42 % of the patients with a score ≥ 7 within 2 h. Conclusions Escalation of patient observations, monitoring and medical reviews matching the BedsidePEWS is still suboptimal. Children with CHC are at higher risk of lower compliance. Impact of adherence to predefined response algorithms on patient outcomes should be further explored.

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