What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study

G. Sefton*, C. McGrath, L. Tume, S. Lane, P. J.G. Lisboa, E. D. Carrol

*Corresponding author for this work

Research output: Contribution to journalArticle (journal)peer-review

24 Citations (Scopus)

Abstract

The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes. Objective: To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs). Method: A before-and-after observational study August 2005-July 2006 (pre), August 2006-July 2007 (post) implementation of PEWs at the tertiary children's hospital. Results: The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (p< 0.001). Fewer admissions required invasive ventilation 62.7% vs 75.2% (p= 0.015) for a shorter median duration; four to two days. The median length of PICU stay reduced; five to three days (p= 0.002). There was a non-significant reduction in mortality (p= 0.47). There was no comparable improvement in outcome seen in external emergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals. Conclusions: Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved.

Original languageEnglish
Pages (from-to)91-99
Number of pages9
JournalIntensive and Critical Care Nursing
Volume31
Issue number2
DOIs
Publication statusPublished - 1 Apr 2015

Keywords

  • Child
  • Deterioration
  • Emergency
  • Paediatric
  • Paediatric Early Warning
  • Pediatric
  • PEW
  • PICU
  • Unplanned admission to PICU

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