Edge Hill University, Ormskirk, UK.
Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
BMC Pediatr. 2022 Jun 24;22(1):365. doi: 10.1186/s12887-022-03411-1.
Paediatric early warning systems (PEWS) alert health professionals to signs of a child's deterioration with the intention of triggering an urgent review and escalating care. They can reduce unplanned critical care transfer, cardiac arrest, and death. Electronic systems may be superior to paper-based systems. The objective of the study was to critically explore the initial experiences and perceptions of health professionals about the acceptability of DETECT e-PEWS, and what factors influence its acceptability.
A descriptive qualitative study (part of The DETECT study) was undertaken February 2020-2021. Single, semi-structured telephone interviews were used. The setting was a tertiary children's hospital, UK. The participants were health professionals working in study setting and using DETECT e-PEWS. Sampling was undertaken using a mix of convenience and snowballing techniques. Participants represented two user-groups: 'documenting vital signs' (D-VS) and 'responding to vital signs' (R-VS). Perceptions of clinical utility and acceptability of DETECT e-PEWS were derived from thematic analysis of transcripts.
Fourteen HPs (12 nurses, 2 doctors) participated; seven in D-VS and seven in the R-VS group. Three main themes were identified: complying with DETECT e-PEWS, circumventing DETECT e-PEWS, and disregarding DETECT e-PEWS. Overall clinical utility and acceptability were deemed good for HPs in the D-VS group but there was diversity in perception in the R-VS group (nurses found it more acceptable than doctors). Compliance was better in the D-VS group where use of DETECT e-PEWS was mandated and used more consistently. Some health professionals circumvented DETECT e-PEWS and fell back into old habits. Doctors (R-VS) did not consistently engage with DETECT e-PEWS, which reduced the acceptability of the system, even in those who thought the system brought benefits.
Speed and accuracy of real-time data, automation of triggering alerts and improved situational awareness were key factors that contributed to the acceptability of DETECT e-PEWS. Mandating use of both recording and responding aspects of DETECT e-PEWS is needed to ensure full implementation.
儿科早期预警系统（PEWS）旨在提醒医护人员注意儿童病情恶化的迹象，从而触发紧急评估和升级护理。该系统可减少非计划性转入重症监护病房、心脏骤停和死亡的发生。电子系统可能优于纸质系统。本研究的目的是批判性地探讨医护人员对 DETECT e-PEWS 的可接受性的初始经验和看法，以及影响其可接受性的因素。
这是一项描述性定性研究（DETECT 研究的一部分），于 2020 年 2 月至 2021 年 2 月进行。采用单一、半结构式电话访谈。研究地点为英国一家三级儿童医院。参与者为在研究环境中工作并使用 DETECT e-PEWS 的医护人员。采用方便抽样和滚雪球抽样相结合的方法进行抽样。参与者代表两个用户群体：“记录生命体征”（D-VS）和“响应生命体征”（R-VS）。通过对转录本的主题分析，得出 DETECT e-PEWS 的临床实用性和可接受性的看法。
共有 14 名医护人员（12 名护士，2 名医生）参与，其中 7 名在 D-VS 组，7 名在 R-VS 组。确定了三个主题：遵守 DETECT e-PEWS、规避 DETECT e-PEWS 和忽视 DETECT e-PEWS。总体而言，D-VS 组的医护人员认为 DETECT e-PEWS 的临床实用性和可接受性良好，但 R-VS 组的看法存在差异（护士比医生更能接受）。在 D-VS 组中，由于强制使用和更一致地使用 DETECT e-PEWS，遵守情况更好。一些医护人员规避了 DETECT e-PEWS，回归旧习惯。医生（R-VS）并没有始终如一地使用 DETECT e-PEWS，这降低了系统的可接受性，即使是那些认为系统带来好处的人也是如此。
实时数据的速度和准确性、警报触发的自动化以及态势感知的改善是 DETECT e-PEWS 可接受性的关键因素。需要强制使用 DETECT e-PEWS 的记录和响应两个方面，以确保全面实施。
