Global Critical Care Research Student St. Jude Children's Research Hospital St. Louis, Missouri, United States
Background: Pediatric Early Warning Systems (PEWS) are tools designated to monitor and assess clinical parameters of pediatric patients, with the aim of improving patient outcomes and preventing severe complications. However, there is insufficient data regarding how healthcare providers perceive the impact of PEWS on patient care across healthcare centers in low-resource settings. Objective: The primary objective of this study is to qualitatively assess the multifaceted perception of outcomes of PEWS implementation in hospitals serving pediatric cancer patients with limited resources. Design/Methods: We conducted a secondary analysis of a qualitative study documenting adaptations in the delivery of PEWS in low-resource Latin American hospitals. Anonymous surveys were developed as part of a larger study to assess the capacity for PEWS sustainability. The surveys were created in Spanish and Portuguese and were distributed to nurses, physicians, ward, and ICU clinicians at 58 medical centers across 11 Latin American countries. The survey included three multiple-choice questions and one open-ended response to assess adaptations made to PEWS implementation. A qualitative analysis of the open-ended responses was conducted, utilizing codes that had been developed in a prior study to describe provider perceptions on the impact of PEWS. The responses were assessed through thematic content analysis by two coders in the MAXQDA software, achieving a kappa of 0.88. Results: Of the 1,909 responses that were analyzed, the impact of PEWS was mentioned in 49% of the responses. The perceived outcomes were assessed at the provider, team, and patient levels, and emphasized the positive impact of PEWS adaptation. PEWS improved team collaboration and communication amongst multidisciplinary teams of clinicians. In turn, this strengthened patient care strategies and improved perceived patient health outcomes. PEWS was vital in facilitating timely interventions, mitigating progression of critical illness, and reducing mortality rates for their pediatric cancer patients. Despite the life-saving benefits that came with PEWS, challenges hindered the tool’s sustainment and efficient utilization. A lack of personnel and limited access to material resources restricted clinicians from properly implementing PEWS and reduced positive outcomes.
Conclusion(s): This study contributes to the existing literature by evaluating the impact of PEWS implementation in resource-limited hospitals. The findings highlight the need for tailored sustainability strategies to maximize PEWS' benefits in low-resource settings.
