Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study

BERNIE CARTER; HOLLY SARON; Sarah Siner; Jennifer Preston; Matthew Peak; Fulya Mehta; Steven Lane; Caroline Lambert; Dawn Jones; Hannah  Hughes; Jane Harris; Leah Evans; Sarah Dee; Chin-Kien Eyton-Chong; Gerri Sefton; Enitan Carrol

doi:10.1186/s12887-022-03411-1

Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study

BERNIE CARTER^*
, HOLLY SARON
, Sarah Siner
, Jennifer Preston
, Matthew Peak
, Fulya Mehta
, Steven Lane
, Caroline Lambert
, Dawn Jones
, Hannah Hughes
, Jane Harris
, Leah Evans
, Sarah Dee
, Chin-Kien Eyton-Chong
, Gerri Sefton
, Enitan Carrol

^*Corresponding author for this work

Alder Hey Children's NHS Foundation Trust
University of Liverpool
Liverpool John Moores University

Research output: Contribution to journal › Article (journal) › peer-review

3 Citations (Scopus)

183 Downloads (Pure)

Abstract

Background
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.
Methods
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.
Results
Fourteen HPs (12 nurses, 2 doctors) participated with 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.
Conclusions
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.

Original language	English
Article number	365
Journal	BMC Pediatrics
Volume	22
Early online date	24 Jun 2022
DOIs	https://doi.org/10.1186/s12887-022-03411-1
Publication status	Published - 24 Jun 2022

Keywords

DETECT study
paediatrics
Paediatric Early Warning Score
Vital Signs
Humans
Electronics
Acceptability
Implementation
Utility
Hospitals
Pews
Deterioration
Critical Care
Qualitative Research
Child
Escalation Of Care
Escalation of care
Paediatric early warning score
PEWS

Access to Document

10.1186/s12887-022-03411-1

DETECT HP Qual paper as accepted-for repositoriesAccepted author manuscript, 280 KBLicence: CC BY
Carter et al 2022 DETECT- HP qualitative paperFinal published version, 1.58 MB

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3 Citations
5 Article (journal)

Assessing the performance of Paediatric Early Warning Scores to predict critical deterioration events in hospitalised children (the DETECT study): a retrospective matched case-control study.
Bracken, A., Lane, S., Siner, S., Jones, D., Lambert, C., Mehta, F., Eyton-Chong, C.-K., Davis, P., Fitzsimons, J., Lim, E., Clerihew, L., CARTER, B., Sefton, G. R. & Carrol, E., 2 Jul 2025, In: BMC Pediatrics. 25, 1, p. 1-10 10 p., 520.
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9 Link opens in a new tab Citations (Scopus)

37 Downloads (Pure)
The economic burden experienced by carers of children who had a critical deterioration at a tertiary children’s hospital in the United Kingdom (the DETECT study): an online survey
Costa, E., Mateus, C., CARTER, B., Siner, S., Jones, D., Evans, L., Preston, J., Mehta, F., Lambert, C., Hollingsworth, B., Carrol, E. & Sefton, G., 31 Aug 2023, In: BMC Pediatrics. 23, 1, p. 1-9 436.
Research output: Contribution to journal › Article (journal) › peer-review

Open Access
File
5 Link opens in a new tab Citations (Scopus)

136 Downloads (Pure)
Using technology to reduce critical deterioration (the DETECT study): a cost analysis of care costs at a tertiary children's hospital in the United Kingdom
Costa, E., Mateus, C., CARTER, B., SARON, H., Eyton-Chong, C.-K., Mehta, F., Lane, S., Siner, S., Dean, J., McNally, C., Lambert, C., Hollingsworth, B., Carrol, E. & Sefton, G., 4 Jul 2023, In: BMC Health Services Research. 23, 1, 725.
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Cite this

CARTER, BERNIE., SARON, HOLLY., Siner, S., Preston, J., Peak, M., Mehta, F., Lane, S., Lambert, C., Jones, D., Hughes, H., Harris, J., Evans, L., Dee, S., Eyton-Chong, C.-K., Sefton, G., & Carrol, E. (2022). Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study. BMC Pediatrics, 22, Article 365. https://doi.org/10.1186/s12887-022-03411-1

@article{e38594f10d074629bb1b8671ca551e86,

title = "Health professionals{\textquoteright} initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study",

abstract = "Background Paediatric early warning systems (PEWS) alert health professionals to signs of a child{\textquoteright}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. Methods 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{\textquoteright}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: {\textquoteleft}documenting vital signs{\textquoteright} (D-VS) and {\textquoteleft}responding to vital signs{\textquoteright} (R-VS). Perceptions of clinical utility and acceptability of DETECT e-PEWS were derived from thematic analysis of transcripts. Results Fourteen HPs (12 nurses, 2 doctors) participated with 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. Conclusions 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. ",

keywords = "DETECT study, paediatrics, Paediatric Early Warning Score, Vital Signs, Humans, Electronics, Acceptability, Implementation, Utility, Hospitals, Pews, Deterioration, Critical Care, Qualitative Research, Child, Escalation Of Care, Escalation of care, Paediatric early warning score, PEWS",

author = "BERNIE CARTER and HOLLY SARON and Sarah Siner and Jennifer Preston and Matthew Peak and Fulya Mehta and Steven Lane and Caroline Lambert and Dawn Jones and Hannah Hughes and Jane Harris and Leah Evans and Sarah Dee and Chin-Kien Eyton-Chong and Gerri Sefton and Enitan Carrol",

note = "Funding Information: We wish to acknowledge the health professionals who participated in the interviews and the research nurses who supported the recruitment of the health professionals during the COVID-19 lockdowns. We wish to acknowledge the support of the NIHR Clinical Research Network, North-West Coast. This report is independent research funded by the National Institute for Health Research (Dynamic Electronic Tracking and Escalation to reduce Critical Care Transfers (The DETECT Study), I4I Challenge award ref. II-LA-0216-20,002). The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. Funding Information: This report is independent research funded by the National Institute for Health Research (Dynamic Electronic Tracking and Escalation to reduce Critical Care Transfers (The DETECT Study), I4I Challenge award ref. II-LA-0216-20,002). The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = jun,

day = "24",

doi = "10.1186/s12887-022-03411-1",

language = "English",

volume = "22",

journal = "BMC Pediatrics",

issn = "1471-2431",

publisher = "BioMed Central Ltd.",

}

CARTER, BERNIE, SARON, HOLLY, Siner, S, Preston, J, Peak, M, Mehta, F, Lane, S, Lambert, C, Jones, D, Hughes, H, Harris, J, Evans, L, Dee, S, Eyton-Chong, C-K, Sefton, G & Carrol, E 2022, 'Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study', BMC Pediatrics, vol. 22, 365. https://doi.org/10.1186/s12887-022-03411-1

Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study. / CARTER, BERNIE; SARON, HOLLY; Siner, Sarah et al.
In: BMC Pediatrics, Vol. 22, 365, 24.06.2022.

Research output: Contribution to journal › Article (journal) › peer-review

TY - JOUR

T1 - Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study

AU - CARTER, BERNIE

AU - SARON, HOLLY

AU - Siner, Sarah

AU - Preston, Jennifer

AU - Peak, Matthew

AU - Mehta, Fulya

AU - Lane, Steven

AU - Lambert, Caroline

AU - Jones, Dawn

AU - Hughes, Hannah

AU - Harris, Jane

AU - Evans, Leah

AU - Dee, Sarah

AU - Eyton-Chong, Chin-Kien

AU - Sefton, Gerri

AU - Carrol, Enitan

N1 - Funding Information: We wish to acknowledge the health professionals who participated in the interviews and the research nurses who supported the recruitment of the health professionals during the COVID-19 lockdowns. We wish to acknowledge the support of the NIHR Clinical Research Network, North-West Coast. This report is independent research funded by the National Institute for Health Research (Dynamic Electronic Tracking and Escalation to reduce Critical Care Transfers (The DETECT Study), I4I Challenge award ref. II-LA-0216-20,002). The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. Funding Information: This report is independent research funded by the National Institute for Health Research (Dynamic Electronic Tracking and Escalation to reduce Critical Care Transfers (The DETECT Study), I4I Challenge award ref. II-LA-0216-20,002). The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. Publisher Copyright: © 2022, The Author(s).

PY - 2022/6/24

Y1 - 2022/6/24

N2 - Background 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. Methods 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. Results Fourteen HPs (12 nurses, 2 doctors) participated with 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. Conclusions 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.

AB - Background 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. Methods 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. Results Fourteen HPs (12 nurses, 2 doctors) participated with 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. Conclusions 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.

KW - DETECT study

KW - paediatrics

KW - Paediatric Early Warning Score

KW - Vital Signs

KW - Humans

KW - Electronics

KW - Acceptability

KW - Implementation

KW - Utility

KW - Hospitals

KW - Pews

KW - Deterioration

KW - Critical Care

KW - Qualitative Research

KW - Child

KW - Escalation Of Care

KW - Escalation of care

KW - Paediatric early warning score

KW - PEWS

UR - https://www.scopus.com/pages/publications/85132856652

UR - https://www.scopus.com/pages/publications/85132856652#tab=citedBy

U2 - 10.1186/s12887-022-03411-1

DO - 10.1186/s12887-022-03411-1

M3 - Article (journal)

C2 - 35751050

SN - 1471-2431

VL - 22

JO - BMC Pediatrics

JF - BMC Pediatrics

M1 - 365

ER -

Health professionals’ initial experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): a qualitative interview study

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Research output

Assessing the performance of Paediatric Early Warning Scores to predict critical deterioration events in hospitalised children (the DETECT study): a retrospective matched case-control study.

The economic burden experienced by carers of children who had a critical deterioration at a tertiary children’s hospital in the United Kingdom (the DETECT study): an online survey

Using technology to reduce critical deterioration (the DETECT study): a cost analysis of care costs at a tertiary children's hospital in the United Kingdom

Cite this