WIP 65 - Implementation of a pediatric early warning system at Botswana’s national referral hospital

Poster Number: WIP 65
Publication Number: WIP 65.970

Background: Identification of children with abnormal vitals and other signs of pending clinical deterioration is challenging in resource-limited, inpatient settings with high patient-to-nurse ratios and minimal continuous monitoring. Pediatric early warning systems (PEWS) are used in resource-limited and replete settings to flag children at risk for deterioration and guide escalation of care. At Botswana’s Princess Marina National Referral Hospital, a 2019 audit revealed that pediatric ward nurses only correctly identified 22% of abnormal vitals for age and only reported 9% of abnormal vitals to a doctor. Delayed escalation of care due to delayed identification of deteriorating children was hypothesized by providers to contribute to mortality, and the ward adopted a PEWS in December 2022.

Objective: This mixed methods implementation research study aimed to 1) explore barriers and facilitators to PEWS implementation in our setting; 2) assess acceptability and feasibility of PEWS; and 3) measure effectiveness of PEWS at reducing unplanned clinical deteriorations.

Design/Methods: Aim 1: Barriers and facilitators will be explored through semi-structured staff interviews coded using the Consolidated Framework for Implementation Research. Interviews concluded in August 2023 and transcript coding is in progress. Aim 2: Acceptability and feasibility will be assessed using the Acceptability and Feasibility of Implementation Measures which were administered via staff survey in June 2023; analysis is in progress. Aim 3: Clinical deterioration events were defined a prior as unplanned ICU transfers, non-palliative mortalities, or initiations of ICU level interventions on the floor. Events were tracked before, during, and after PEWS implementation (14 months). Event tracking ended in September 2023 and analysis comparing pre- and post-PEWS rates is in progress. IRB approval for this study was obtained from the Ministry of Health of Botswana, Princess Marina Hospital, and Children’s Hospital of Philadelphia.