Critically Ill Children
Conditions
Keywords
BedsidePEWS, Intensive Care
Brief summary
The purpose of this study is to evaluate the impact of Bedside Paediatric Early Warning System (Bedside-PEWS) on early identification of children at risk for near and actual cardiopulmonary arrest, hospital mortality, processes of care and PICU resource utilization.
Detailed description
The Bedside Paediatric Early Warning System (Bedside PEWS) is a scientifically developed documentation-based system of care designed to identify children who are clinically deteriorating while admitted to hospital inpatient wards. It was developed and validated by the applicants. The investigators have preliminary data demonstrating that the Bedside PEWS addresses multiple factors (communication, hierarchy, secondary review) contributing to delayed treatment of children at risk. In our pilot study of implementation at a single site the investigators showed statistically significant reductions in late transfers, 'stat' calls, decreased apprehension when nurses called physicians to review patients, and improved communication. Our preliminary data show that the Bedside PEWS score is superior to other methods being used to identify children at risk for impending cardiopulmonary arrest. A 2-year cluster-randomized trial will evaluate the impact of Bedside PEWS on clinical outcomes, processes of care and resource utilization in 22 paediatric hospitals.
Interventions
OTHERImplementation of Bedside Paediatric Early Warning System
The Bedside Paediatric Early Warning System (Bedside PEWS) is a documentation-based system of care that will replace existing documentation systems for vital signs in inpatient ward areas in hospitals randomized to implement Bedside-PEWS. Frontline staff education within each hospital will occur over a period of three months preceding a 5 week run-in implementation phase, which will be followed by hospital-wide implementation. The Bedside-PEWS documentation record will become the primary method of documentation for vital signs and related data.
Hospitals randomized to standard care will continue with established methods of care. This will include the use of calling criteria and/or the expert model to identify children at risk. As in intervention hospitals, existing MET-RRT practices, established staffing and documentation practices will continue.
Sponsors
The Hospital for Sick Children
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
1 Days to 18 Years
Healthy volunteers
No
Inclusion criteria
For Hospitals: * provide care for more than 200 inpatient admissions aged \<18 years and \>37 weeks gestational age in eligible inpatient wards each year * have specialised paediatric physicians (including paediatricians, paediatric surgeons, other paediatric sub-specialists) and, one or more intensive care unit (PICU) that provides care for children. A PICU is a designated, staffed area for prolonged mechanical ventilation, invasive monitoring and circulatory support for children- including but not limited to neonates. Other areas designated for patients of increased acuity, such as 'constant observation' or 'high dependency' or 'step-down' units will be regarded as part of the PICU where the PICU staff physicians are wholly or jointly responsible for the care of children in these areas (can write orders in the chart). * may or may not have a MET-RRT for children. A MET-RRT is defined as an identified team of one or more trained healthcare professionals who report to an on service PICU physician, and perform urgent consultations on hospital inpatients. For inpatient wards: * areas where care is provided to patients who are admitted to the hospital, other than PICU, operating rooms, and other designated areas where anaesthetist-supervised procedures are performed. All eligible inpatient wards will participate in the study. For patients: Within eligible hospitals we will study patients older than 37 weeks gestational age and less than 18 years who are admitted to eligible inpatient wards, who receive care in an eligible inpatient area during the study.
Exclusion criteria
For hospitals: * have plans to introduce a new 'medical emergency team' during the study, and where a severity of illness score (Brighton, Cardiff, PEWS, Bedside PEWS or other unpublished score) is used in ward areas * hospitals where randomization is not deemed acceptable. These
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| All Cause Hospital Mortality (Intervention Phase) | for 52 weeks starting at Week 31 | All cause hospital mortality includes all deaths of eligible inpatients who were cared for in an eligible inpatient ward and will be prospectively assessed for 52 weeks following the 5-week run in period at intervention hospitals. The following sub-group analyses will be performed: \[1\] Hospital size. Hospitals with \>200 eligible inpatient ward beds will be one group and those with \<200 eligible inpatient ward beds the other. \[2\] Hospitals with and without medical emergency teams. \[3\] Hospitals with ECMO for children. \[4\] patients with urgent PICU admission initiated in an inpatient ward. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Significant Clinical Deterioration Events | for 26 weeks starting at Week 0 (baseline) and for 52 weeks starting at week 31 (intervention) | This will be defined as the provision of significant respiratory or circulatory therapies or cardiopulmonary resuscitation in the 12 hours before transfer from inpatient ward, or death without DNR order in an inpatient ward. The following sub-group analyses will be performed: \[1\] Hospital size. Hospitals with \>200 eligible inpatient ward beds will be one group and those with \<200 eligible inpatient ward beds the other. \[2\] Hospitals with and without medical emergency teams. \[3\] Hospitals with ECMO for children. \[4\] patients with urgent PICU admission initiated in an inpatient ward. |
Countries
Belgium, Canada, Ireland, Italy, Netherlands, New Zealand, United Kingdom
Outcome results
None listed