San Antonio Uniformed Services Health Education Consortium, Department of Pediatrics, Brooke Army Medical Center, Joint Base San Antonio Fort Sam Houston, Texas.
San Antonio Uniformed Services Health Education Consortium, Department of Pediatrics, Brooke Army Medical Center, Joint Base San Antonio Fort Sam Houston, Texas
Pediatrics. 2021 Mar;147(3). doi: 10.1542/peds.2019-1947. Epub 2021 Feb 5.
The Pediatric Early Warning Score (PEWS) is an evidence-based tool that allows early collaborative assessment and intervention for a rapid response team (RRT) activation. The goal of our quality improvement initiative was to reduce the percentage of unnecessary RRT activations by 50% over 2 years without increasing PICU transfers or compromising patient safety and timely evaluation.
A PEWS system replaced preexisting vital signs-based pediatric RRT criteria and was modified through plan-do-study-act cycles. Unnecessary RRT activations, total RRT activation rate, transfers to the PICU, total clinical interventions performed per RRT, and missed RRT activation rate were compared between intervention periods. Likert scale surveys were administered to measure satisfaction with each modification.
There was a significant decrease in the percentage of unnecessary RRT activations from 33% to 3.5% after the implementation of the PEWS and modified-PEWS systems ( < .05). The RRT activation rate decreased from 22.6 to 13.3 RRT activations per 1000 patient care days after implementation of the PEWS and modified-PEWS systems ( < .05), without changes in PICU transfer rates. Physicians reported that the PEWS system improved nursing communication and accuracy of RRT criteria ( < .05). Nursing reported that the PEWS system improved patient management and clinical autonomy ( < .05).
The PEWS systems have been an effective means of identifying deteriorating pediatric patients and reducing unnecessary RRT activations. The new system fosters collaboration and communication at the bedside to prevent acute deterioration, perform timely interventions, and ultimately improve patient safety and outcomes.
儿科早期预警评分（PEWS）是一种循证工具，可用于对快速反应团队（RRT）的激活进行早期协作评估和干预。我们质量改进计划的目标是在 2 年内将不必要的 RRT 激活率降低 50%，同时不增加 PIC 病房的转科率或影响患者安全和及时评估。
PEWS 系统取代了基于生命体征的现有儿科 RRT 标准，并通过计划-执行-研究-行动循环进行了修改。比较干预前后不必要的 RRT 激活率、总 RRT 激活率、转至 PIC 病房率、每例 RRT 实施的总临床干预率和漏报的 RRT 激活率。通过李克特量表调查来衡量对每个修改的满意度。
实施 PEWS 和改良-PEWS 系统后，不必要的 RRT 激活率从 33%降至 3.5%（<0.05）。实施 PEWS 和改良-PEWS 系统后，RRT 激活率从 22.6 降至 13.3 例/1000 个患者护理日（<0.05），而 PIC 病房转科率无变化。医生报告说 PEWS 系统改善了护理沟通和 RRT 标准的准确性（<0.05）。护士报告说 PEWS 系统改善了患者管理和临床自主性（<0.05）。
PEWS 系统是识别儿科患者病情恶化和减少不必要的 RRT 激活的有效手段。新系统促进了床边协作和沟通，以防止病情急性恶化，及时进行干预，最终提高患者的安全和预后。
