BACKGROUND The rapid identification of deterioration in the pediatric population is complex, particularly in the emergency department (ED). A comprehensive multi-faceted Pediatric Early Warning System (PEWS) might maximize early recognition of clinical deterioration and provide a structured process for the reassessment and escalation of care. The objective of the study was to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS implemented in the ED of an urban public general hospital in British Columbia, Canada, and to guide provincial scale up. METHODS We used a before-and-after design to evaluate the implementation fidelity, effectiveness, and utility of a 5-component PEWS (pediatric assessment flowsheet, PEWS score, situational awareness, escalation aid, and communication framework). Sources of data included patient medical records, surveys of direct care staff, and key-informant interviews. Data were analyzed using mixed-methods approaches. RESULTS The majority of medical records had documented PEWS scores at triage (80%) and first bedside assessment (81%), indicating that the intervention was implemented with high fidelity. The intervention was effective in increasing vital signs documentation, both at first beside assessment (84% increase) and throughout the ED stay (> 100% increase), in improving staff's self-perceived knowledge and confidence in providing pediatric care, and self-reported communication between staff. Satisfaction levels were high with the PEWS scoring system, flowsheet, escalation aid, and to a lesser extent with the situational awareness tool and communication framework. Reasons for dissatisfaction included increased paperwork and incidence of false-positives. Overall, the majority of providers indicated that implementation of PEWS and completing a PEWS score at triage alongside the Canadian Triage and Acuity Scale (CTAS) added value to pediatric care in the ED. Results also suggest that the intervention is aligned with current practice in the ED. CONCLUSION Our study shows that high-fidelity implementation of PEWS in the ED is feasible. We also show that a multi-component PEWS can be effective in improving pediatric care and be well-accepted by staff. Results and lessons learned from this pilot study are being used to scale up implementation of PEWS in ED settings across the province of British Columbia.

中文翻译：

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在加拿大不列颠哥伦比亚省的一个急诊科中对5种成分的儿科预警系统（PEWS）进行实施研究，以告知省级扩大规模。

背景技术快速识别小儿人口的恶化是复杂的，特别是在急诊科（ED）。全面的多方面儿科预警系统（PEWS）可以最大程度地早期识别临床恶化情况，并为医疗的重新评估和升级提供结构化的过程。该研究的目的是评估在加拿大不列颠哥伦比亚省一家城市公立综合医院急诊室实施的5组分PEWS的实施保真度，有效性和效用，并指导省级规模扩大。方法我们使用前后设计来评估5分量PEWS（儿科评估流程图，PEWS评分，情境意识，升级帮助和沟通框架）的保真度，有效性和实用性。数据来源包括患者病历，直接护理人员调查以及关键信息访谈。使用混合方法分析数据。结果大多数医疗记录都记录了PEWS分诊（80％）和首次床旁评估（81％）的得分，表明该干预措施的保真度很高。这项干预措施有效地增加了生命体征文档，无论是在评估初期（84％的增加）还是在急诊室的整个住院期间（> 100％的增加），都提高了员工的自我认知和对提供儿科护理的信心，并自我报告员工之间的沟通。PEWS评分系统，流程图，上报辅助工具的满意度很高，而情境意识工具和沟通框架的满意度较低。不满意的原因包括文书工作增加和假阳性的发生率。总体而言，大多数医疗服务提供者表示，PEWS的实施和在分诊时完成PEWS评分以及加拿大分诊和敏锐度表（CTAS）为ED中的儿科护理增添了价值。结果还表明，该干预措施与急诊室当前的做法相吻合。结论我们的研究表明，在ED中高保真地实现PEWS是可行的。我们还表明，多组分PEWS可以有效改善儿科护理并得到员工的普遍接受。从该试点研究中获得的结果和经验教训被用于扩大不列颠哥伦比亚省在急诊室环境中PEWS的实施。大多数提供者表示，PEWS的实施以及在分诊中完成PEWS评分以及加拿大分诊和敏锐度量表（CTAS）为ED中的儿科护理增加了价值。结果还表明，该干预措施与急诊室当前的做法相吻合。结论我们的研究表明，在ED中高保真地实现PEWS是可行的。我们还表明，多组分PEWS可以有效改善儿科护理并得到员工的普遍接受。从该试点研究中获得的结果和经验教训被用于扩大不列颠哥伦比亚省在急诊室环境中PEWS的实施。大多数提供者表示，PEWS的实施以及在分诊中完成PEWS评分以及加拿大分诊和敏锐度量表（CTAS）为ED中的儿科护理增加了价值。结果还表明，该干预措施与急诊室当前的做法相吻合。结论我们的研究表明，在ED中高保真地实现PEWS是可行的。我们还表明，多组分PEWS可以有效改善儿科护理并得到员工的广泛认可。从该试点研究中获得的结果和经验教训被用于扩大不列颠哥伦比亚省在急诊室环境中PEWS的实施。结果还表明，该干预措施与急诊室当前的做法相吻合。结论我们的研究表明，在ED中高保真地实现PEWS是可行的。我们还表明，多组分PEWS可以有效改善儿科护理并得到员工的广泛认可。从该试点研究中获得的结果和经验教训被用于扩大不列颠哥伦比亚省在急诊室环境中PEWS的实施。结果还表明，该干预措施与急诊室当前的做法相吻合。结论我们的研究表明，在ED中高保真地实现PEWS是可行的。我们还表明，多组分PEWS可以有效改善儿科护理并得到员工的广泛认可。从该试点研究中获得的结果和经验教训被用于扩大不列颠哥伦比亚省在急诊室环境中PEWS的实施。