scholarly journals Pediatric Early Warning Systems aid in triage to intermediate versus intensive care for pediatric oncology patients in resource-limited hospitals

2018 ◽  
Vol 65 (8) ◽  
pp. e27076 ◽  
Author(s):  
Asya Agulnik ◽  
Anisha Nadkarni ◽  
Lupe Nataly Mora Robles ◽  
Dora Judith Soberanis Vasquez ◽  
Ricardo Mack ◽  
...  
Keyword(s):  
Intensive Care ◽  
Pediatric Oncology ◽  
Early Warning ◽  
Early Warning Systems ◽  
Warning Systems ◽  
Oncology Patients ◽  
Resource Limited

scholarly journals Validation of a pediatric early warning system for hospitalized pediatric oncology patients in a resource‐limited setting

Cancer ◽  
2017 ◽  
Vol 123 (24) ◽  
pp. 4903-4913 ◽  
Author(s):  
Asya Agulnik ◽  
Alejandra Méndez Aceituno ◽  
Lupe Nataly Mora Robles ◽  
Peter W. Forbes ◽  
Dora Judith Soberanis Vasquez ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Early Warning ◽  
Early Warning System ◽  
Warning System ◽  
Resource Limited Setting ◽  
Oncology Patients ◽  
Resource Limited ◽  
Limited Setting

scholarly journals Successful Implementation of a Pediatric Early Warning Score in a Resource-Limited Pediatric Oncology Hospital in Guatemala

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 60s-60s
Author(s):  
Asya Agulnik ◽  
Dora Judith Soberanis Vasquez ◽  
Jose Emigdio García Ortiz ◽  
Lupe Nataly Mora Robles ◽  
Ricardo Mack ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Pediatric Oncology ◽  
Early Warning ◽  
Conflicts Of Interest ◽  
Low Cost ◽  
Early Warning Score ◽  
Level Of Care ◽  
Successful Implementation ◽  
Oncology Patients ◽  
Resource Limited

Abstract 25 Background: Hospitalized pediatric oncology patients are at high risk for clinical decline and mortality, particularly in resource-limited settings. Pediatric Early Warning Scores (PEWS) are commonly used to aid with early identification of clinical deterioration; however, these scores have never been studied in oncology patients in low-resource settings. We describe the successful implementation of a modified PEWS at Unidad Nacional de Oncología Pediátrica (UNOP), a national pediatric oncology hospital in Guatemala. Methods: The PEWS used at Boston Children's Hospital (BCH) was modified through key informant meetings at UNOP, adjusting for practice variations between the two hospitals. After an initial pilot of the tool, the PEWS was implemented in all non-ICU inpatient areas at UNOP (60 beds with about 2,000 admissions/year). During implementation, systems were created to monitor errors in calculating PEWS, patient transfers to a higher level of care, and high PEWS scores for ongoing quality improvement. Results: Hospital-wide implementation occurred over 6 months, when 113 nurses were trained in the PEWS tool and algorithm. Compliance with PEWS performance and documentation was 100% by the end of the implementation period, with 300 to 400 PEWS measured daily and less than 10% errors. Monitoring of PEWS results reports an average of 5 high PEWS per week with 30% transferring to a higher level of care. Among patients requiring ICU transfer, 86% had an abnormal PEWS prior to transfer, which is similar to results at BCH (90%). Staff surveys showed a high degree of satisfaction with PEWS (4.6/5) and minimal difficulty using the score (2.3/5) (n=67). Conclusions: We describe the successful implementation of a PEWS in a pediatric oncology hospital in Guatemala. This work demonstrates that PEWS is a feasible, well-accepted, and low-cost quality improvement measure in this resource-limited setting. We now plan to evaluate the effects of this implementation on patient care and outcomes. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

scholarly journals Qualitative Study of Pediatric Early Warning Systems’ Impact on Interdisciplinary Communication in Two Pediatric Oncology Hospitals With Varying Resources

2020 ◽  
pp. 1079-1086
Author(s):  
Dylan Graetz ◽  
Erica C. Kaye ◽  
Marcela Garza ◽  
Gia Ferrara ◽  
Mario Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Qualitative Study ◽  
Pediatric Oncology ◽  
Interdisciplinary Communication ◽  
Limited Resource ◽  
Early Warning Systems ◽  
The United States ◽  
Warning Systems ◽  
Care Providers

PURPOSE Hospitalized pediatric oncology patients are at high risk of deterioration and require frequent interdisciplinary communication to deliver high-quality care. Pediatric early warning systems (PEWS) are used by hospitals to reduce deterioration, but it is unknown how these systems affect communication about patient care in high- and limited-resource pediatric oncology settings. METHODS This qualitative study included semistructured interviews describing PEWS and subsequent team communication at 2 pediatric cancer centers, 1 in the United States and 1 in Guatemala. Participants included nurses, and frontline and intensive care providers who experienced recent deterioration events. Transcripts were coded and analyzed inductively using MAXQDA software. RESULTS The study included 41 providers in Guatemala and 42 providers in the United States (33 nurses, 30 ward providers, and 20 pediatric intensive care providers). Major themes identified include “hierarchy,” “empowerment,” “quality and method of communication,” and “trigger.” All providers described underlying medical hierarchies affecting the quality of communication regarding patient deterioration events and identified PEWS as empowering. Participants from the United States described the algorithmic approach to care and technology associated with PEWS contributing to impaired clinical judgement and a lack of communication. In both settings, PEWS sparked interdisciplinary communication and inspired action. CONCLUSION PEWS enhance interdisciplinary communication in high- and limited-resource study settings by empowering bedside providers. Traditional hierarchies contributed to negative communication and, in well-resourced settings, technology and automation resulted in lack of communication. Understanding contextual elements is integral to optimizing PEWS and improving pediatric oncology outcomes in hospitals of all resource levels.

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