Implementation of the bedside paediatric early warning system, its sustainability in clinical practice and patient outcomes: a quality improvement initiative.

Background: Paediatric patients in acute care unit settings may be deprived of frequent assessments and monitoring. These spaced observations can put patients at risk of missed clinical deterioration that could ultimately result in unfavourable safety events. Several international guidelines encourage the use of the Paediatric Early Warning System (PEWS), which provides healthcare workers with a standardised approach to monitor patients' clinical status and anticipate deterioration at an early stage. This study aimed to summarise the strategies used for implementing the PEWS and evaluate the impact of this tool on patient safety.

Method: We conducted a quality improvement project to implement the Bedside PEWS in 2016. Six plan-do-study-act cycles were used throughout the implementation phase. Three elements were monitored to ensure the proper utilisation of the tool: monitoring, escalation and physician review of patients based on the PEWS protocol. Outcome measures of this initiative were monitored to explore the impact of the PEWS on patient safety.

Result: The average number of unplanned paediatric intensive care unit (PICU) admissions increased by 25% in 2017, decreased by 25% in 2018 and decreased by 50% in 2019 compared with the baseline year. The average number of unplanned paediatric high-dependency unit admissions increased by 14.3% in 2017, decreased by 28.6% in 2018 and decreased by 42.9% in 2019 compared with the baseline year. The average length of stay after unplanned PICU admission remained stable in 2016 and 2017 and decreased by 50% from 2018 to 2022 relative to the baseline year. The mortality rate after unplanned PICU admission was also reduced. There was no effect on the cardiopulmonary arrest rate outside of PICUs.

Conclusion: Continuous staff training results in a high compliance rate with the PEWS protocol, despite persistent hospital expansion and high staff turnover. PEWS positively affects patient outcomes.