Dynamic Electronic Tracking and Escalation to reduce Critical care Transfers (DETECT): the protocol for a stepped wedge mixed method study to explore the clinical effectiveness, clinical utility and cost-effectiveness of an electronic physiological surveillance system for use in children

BERNIE CARTER, Gerri Sefton, Steven Lane, Matthew Peak, Ceu Mateus, Jennifer Preston, Fulya Mehta, Bruce Hollingsworth, Roger Killen, Enitan Carrol

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Abstract

Background
Active monitoring of hospitalised adults, using handheld electronic physiological surveillance systems, is associated with reduced in-patient mortality in the UK. Potential also exists to improve the recognition and response to deterioration in hospitalised children. However, the clinical effectiveness, the clinical utility, and the cost-effectiveness of this technology to reduce paediatric critical deterioration, have not been evaluated in an NHS environment.
Method
This is a non-randomised stepped-wedge prospective mixed methods study. Participants will be in-patients under the age of 18 years, at a tertiary children’s hospital. Day-case, neonatal surgery and Paediatric Intensive Care patients will be excluded.
The intervention is the implementation of Careflow Vitals and Connect (System C) to document vital signs and sepsis screening. The underpinning age-specific Paediatric Early Warning (PEWS) risk model calculates PEWS and provides associated clinical decision support. Real-time data of deterioration risk are immediately visible to the entire clinical team to optimise situation awareness, the chronology of the escalation and response are captured with automated reporting of the organisational safety profile.
Baseline data will be collected prospectively for one year preceding the intervention. Following a three month implementation period, one year of post-intervention data will be collected.
The primary outcome is unplanned transfers to critical care (HDU and/or PICU). The secondary outcomes are critical deterioration events (CDE), the timeliness of critical care transfer, the critical care interventions required, critical care length of stay and outcome.
The clinical effectiveness will be measured by prevalence of critical deterioration events (CDE) per 1,000 hospital admissions and per 1,000 non-ICU bed days.
Observation, field notes, e-surveys and focused interviews will be used to establish the clinical utility of the technology to healthcare professionals and the acceptability to in-patient families. The cost-effectiveness will be analysed using Health Related Group costs per day for the critical care and hospital stay for up to 90 days post CDE.
Discussion
If the technology is effective at reducing CDE in hospitalised children it could be deployed widely, to reduce morbidity and mortality, and associated costs.
Original languageEnglish
Number of pages7
JournalBMC Pediatrics
Early online date17 Oct 2019
Publication statusPublished - 19 Oct 2019

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Critical Care
Cost-Benefit Analysis
Hospitalized Child
Pediatrics
Technology
Length of Stay
Patient Acceptance of Health Care
Clinical Decision Support Systems
Chronology
Costs and Cost Analysis
Mortality
Vital Signs
Tertiary Care Centers
Transfer (Psychology)
Sepsis
Observation
Interviews
Morbidity
Safety
Health

Keywords

  • Deterioration
  • sepsis
  • VitalPAC®
  • Paediatric Early Warning (PEWS)
  • e-obs
  • Careflow Vitals and Connect

Cite this

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title = "Dynamic Electronic Tracking and Escalation to reduce Critical care Transfers (DETECT): the protocol for a stepped wedge mixed method study to explore the clinical effectiveness, clinical utility and cost-effectiveness of an electronic physiological surveillance system for use in children",
abstract = "BackgroundActive monitoring of hospitalised adults, using handheld electronic physiological surveillance systems, is associated with reduced in-patient mortality in the UK. Potential also exists to improve the recognition and response to deterioration in hospitalised children. However, the clinical effectiveness, the clinical utility, and the cost-effectiveness of this technology to reduce paediatric critical deterioration, have not been evaluated in an NHS environment. MethodThis is a non-randomised stepped-wedge prospective mixed methods study. Participants will be in-patients under the age of 18 years, at a tertiary children’s hospital. Day-case, neonatal surgery and Paediatric Intensive Care patients will be excluded. The intervention is the implementation of Careflow Vitals and Connect (System C) to document vital signs and sepsis screening. The underpinning age-specific Paediatric Early Warning (PEWS) risk model calculates PEWS and provides associated clinical decision support. Real-time data of deterioration risk are immediately visible to the entire clinical team to optimise situation awareness, the chronology of the escalation and response are captured with automated reporting of the organisational safety profile.Baseline data will be collected prospectively for one year preceding the intervention. Following a three month implementation period, one year of post-intervention data will be collected. The primary outcome is unplanned transfers to critical care (HDU and/or PICU). The secondary outcomes are critical deterioration events (CDE), the timeliness of critical care transfer, the critical care interventions required, critical care length of stay and outcome. The clinical effectiveness will be measured by prevalence of critical deterioration events (CDE) per 1,000 hospital admissions and per 1,000 non-ICU bed days. Observation, field notes, e-surveys and focused interviews will be used to establish the clinical utility of the technology to healthcare professionals and the acceptability to in-patient families. The cost-effectiveness will be analysed using Health Related Group costs per day for the critical care and hospital stay for up to 90 days post CDE. DiscussionIf the technology is effective at reducing CDE in hospitalised children it could be deployed widely, to reduce morbidity and mortality, and associated costs.",
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author = "BERNIE CARTER and Gerri Sefton and Steven Lane and Matthew Peak and Ceu Mateus and Jennifer Preston and Fulya Mehta and Bruce Hollingsworth and Roger Killen and Enitan Carrol",
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Dynamic Electronic Tracking and Escalation to reduce Critical care Transfers (DETECT): the protocol for a stepped wedge mixed method study to explore the clinical effectiveness, clinical utility and cost-effectiveness of an electronic physiological surveillance system for use in children. / CARTER, BERNIE; Sefton, Gerri; Lane, Steven; Peak, Matthew; Mateus, Ceu; Preston, Jennifer; Mehta, Fulya; Hollingsworth, Bruce; Killen, Roger; Carrol, Enitan.

In: BMC Pediatrics, 19.10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dynamic Electronic Tracking and Escalation to reduce Critical care Transfers (DETECT): the protocol for a stepped wedge mixed method study to explore the clinical effectiveness, clinical utility and cost-effectiveness of an electronic physiological surveillance system for use in children

AU - CARTER, BERNIE

AU - Sefton, Gerri

AU - Lane, Steven

AU - Peak, Matthew

AU - Mateus, Ceu

AU - Preston, Jennifer

AU - Mehta, Fulya

AU - Hollingsworth, Bruce

AU - Killen, Roger

AU - Carrol, Enitan

PY - 2019/10/19

Y1 - 2019/10/19

N2 - BackgroundActive monitoring of hospitalised adults, using handheld electronic physiological surveillance systems, is associated with reduced in-patient mortality in the UK. Potential also exists to improve the recognition and response to deterioration in hospitalised children. However, the clinical effectiveness, the clinical utility, and the cost-effectiveness of this technology to reduce paediatric critical deterioration, have not been evaluated in an NHS environment. MethodThis is a non-randomised stepped-wedge prospective mixed methods study. Participants will be in-patients under the age of 18 years, at a tertiary children’s hospital. Day-case, neonatal surgery and Paediatric Intensive Care patients will be excluded. The intervention is the implementation of Careflow Vitals and Connect (System C) to document vital signs and sepsis screening. The underpinning age-specific Paediatric Early Warning (PEWS) risk model calculates PEWS and provides associated clinical decision support. Real-time data of deterioration risk are immediately visible to the entire clinical team to optimise situation awareness, the chronology of the escalation and response are captured with automated reporting of the organisational safety profile.Baseline data will be collected prospectively for one year preceding the intervention. Following a three month implementation period, one year of post-intervention data will be collected. The primary outcome is unplanned transfers to critical care (HDU and/or PICU). The secondary outcomes are critical deterioration events (CDE), the timeliness of critical care transfer, the critical care interventions required, critical care length of stay and outcome. The clinical effectiveness will be measured by prevalence of critical deterioration events (CDE) per 1,000 hospital admissions and per 1,000 non-ICU bed days. Observation, field notes, e-surveys and focused interviews will be used to establish the clinical utility of the technology to healthcare professionals and the acceptability to in-patient families. The cost-effectiveness will be analysed using Health Related Group costs per day for the critical care and hospital stay for up to 90 days post CDE. DiscussionIf the technology is effective at reducing CDE in hospitalised children it could be deployed widely, to reduce morbidity and mortality, and associated costs.

AB - BackgroundActive monitoring of hospitalised adults, using handheld electronic physiological surveillance systems, is associated with reduced in-patient mortality in the UK. Potential also exists to improve the recognition and response to deterioration in hospitalised children. However, the clinical effectiveness, the clinical utility, and the cost-effectiveness of this technology to reduce paediatric critical deterioration, have not been evaluated in an NHS environment. MethodThis is a non-randomised stepped-wedge prospective mixed methods study. Participants will be in-patients under the age of 18 years, at a tertiary children’s hospital. Day-case, neonatal surgery and Paediatric Intensive Care patients will be excluded. The intervention is the implementation of Careflow Vitals and Connect (System C) to document vital signs and sepsis screening. The underpinning age-specific Paediatric Early Warning (PEWS) risk model calculates PEWS and provides associated clinical decision support. Real-time data of deterioration risk are immediately visible to the entire clinical team to optimise situation awareness, the chronology of the escalation and response are captured with automated reporting of the organisational safety profile.Baseline data will be collected prospectively for one year preceding the intervention. Following a three month implementation period, one year of post-intervention data will be collected. The primary outcome is unplanned transfers to critical care (HDU and/or PICU). The secondary outcomes are critical deterioration events (CDE), the timeliness of critical care transfer, the critical care interventions required, critical care length of stay and outcome. The clinical effectiveness will be measured by prevalence of critical deterioration events (CDE) per 1,000 hospital admissions and per 1,000 non-ICU bed days. Observation, field notes, e-surveys and focused interviews will be used to establish the clinical utility of the technology to healthcare professionals and the acceptability to in-patient families. The cost-effectiveness will be analysed using Health Related Group costs per day for the critical care and hospital stay for up to 90 days post CDE. DiscussionIf the technology is effective at reducing CDE in hospitalised children it could be deployed widely, to reduce morbidity and mortality, and associated costs.

KW - Deterioration

KW - sepsis

KW - VitalPAC®

KW - Paediatric Early Warning (PEWS)

KW - e-obs

KW - Careflow Vitals and Connect

M3 - Article

JO - BMC Pediatrics

JF - BMC Pediatrics

SN - 1471-2431

ER -