Graetz Dylan, Kaye Erica C, Garza Marcela, Ferrara Gia, Rodriguez Mario, Soberanis Vásquez Dora Judith, Méndez Aceituno Alejandra, Antillon-Klussmann Federico, Gattuso Jami S, Mandrell Belinda N, Baker Justin N, Rodriguez-Galindo Carlos, Mack Jennifer W, Agulnik Asya
St. Jude Children's Research Hospital, Memphis, TN.
Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala.
JCO Glob Oncol. 2020 Jul;6:1079-1086. doi: 10.1200/GO.20.00163.
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.
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.
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.
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.
住院的儿科肿瘤患者病情恶化风险高，需要频繁进行跨学科沟通以提供高质量护理。医院使用儿科早期预警系统（PEWS）来减少病情恶化，但尚不清楚这些系统如何影响资源丰富和资源有限的儿科肿瘤环境中有关患者护理的沟通。
这项定性研究包括对两个儿科癌症中心（一个在美国，一个在危地马拉）的PEWS及随后的团队沟通进行半结构化访谈。参与者包括护士以及经历过近期病情恶化事件的一线和重症监护人员。使用MAXQDA软件对访谈记录进行编码和归纳分析。
该研究包括危地马拉的41名医护人员和美国的42名医护人员（33名护士、30名病房医护人员和20名儿科重症监护人员）。确定的主要主题包括“等级制度”“赋权”“沟通质量和方式”以及“触发因素”。所有医护人员都描述了影响患者病情恶化事件沟通质量的潜在医疗等级制度，并认为PEWS具有赋权作用。来自美国的参与者描述了与PEWS相关的护理算法方法和技术，这些导致临床判断受损和沟通不足。在这两种环境中，PEWS都引发了跨学科沟通并激发了行动。
PEWS通过赋予床边医护人员权力，在资源丰富和资源有限的研究环境中增强了跨学科沟通。传统等级制度导致沟通不良，在资源丰富的环境中，技术和自动化导致沟通不足。了解背景因素对于优化PEWS和改善所有资源水平医院的儿科肿瘤治疗效果至关重要。
