Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme: the PUMA mixed methods study

BMC Health Services Research

Gerri Sefton¹  Jennifer Preston²  David Lacy³  Amy Lloyd⁴  Kerenza Hood⁴  Khadijeh Taiyari⁴  Rob Trubey⁴  Emma Thomas-Jones⁴  Heather Strange⁴  Nina Jacob⁴  Jacqueline Hughes⁴  Yvonne Moriarty⁴  Dawn Edwards⁵  Colin Powell⁶  Chao Huang⁷  Alison Oliver⁸  Richard Skone⁸  Damian Roland⁹  Lyvonne Tume^1,10  Ian Sinha^1,11  Davina Allen^1,11 

[1] Alder Hey Children’s Hospital, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, UK;Alder Hey Clinical Research Facility, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Eaton Rd, Liverpool, UK;Arrow Park Hospital, Wirral University Teaching NHS Foundation Trust, Wirral, UK;Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK;Children’s Services, Swansea Bay University Health Board, Swansea, UK;Department of Emergency Medicine, Sidra Medicine, Doha, Qatar;Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK;Hull-York Medical School, University of Hull, Hull, UK;Noah’s Ark Children’s Hospital for Wales, Cardiff and Vale University Health Board, Cardiff, UK;Paediatric Emergency Medicine, Leicester Academic (PEMLA) Group, Emergency Department, University of Leicester, Leicester, UK;SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK;School of Health and Society, University of Salford, Manchester, UK;School of Healthcare Sciences, Cardiff University, Room 13.08, Eastgate House, Newport Road, CF24 0AB, Cardiff, UK;

关键词: Paediatric early warning systems;    Healthcare improvement;    Quality improvement;   

DOI  :  10.1186/s12913-021-07314-2

来源: Springer

【 摘 要 】

BackgroundPaediatric mortality rates in the United Kingdom are amongst the highest in Europe. Clinically missed deterioration is a contributory factor. Evidence to support any single intervention to address this problem is limited, but a cumulative body of research highlights the need for a systems approach.MethodsAn evidence-based, theoretically informed, paediatric early warning system improvement programme (PUMA Programme) was developed and implemented in two general hospitals (no onsite Paediatric Intensive Care Unit) and two tertiary hospitals (with onsite Paediatric Intensive Care Unit) in the United Kingdom. Designed to harness local expertise to implement contextually appropriate improvement initiatives, the PUMA Programme includes a propositional model of a paediatric early warning system, system assessment tools, guidance to support improvement initiatives and structured facilitation and support.Each hospital was evaluated using interrupted time series and qualitative case studies. The primary quantitative outcome was a composite metric (adverse events), representing the number of children monthly that experienced one of the following: mortality, cardiac arrest, respiratory arrest, unplanned admission to Paediatric Intensive Care Unit, or unplanned admission to Higher Dependency Unit. System changes were assessed qualitatively through observations of clinical practice and interviews with staff and parents. A qualitative evaluation of implementation processes was undertaken.ResultsAll sites assessed their paediatric early warning systems and identified areas for improvement. All made contextually appropriate system changes, despite implementation challenges. There was a decline in the adverse event rate trend in three sites; in one site where system wide changes were organisationally supported, the decline was significant (ß = -0.09 (95% CI: − 0.15, − 0.05); p = < 0.001). Changes in trends coincided with implementation of site-specific changes.ConclusionsSystem level change to improve paediatric early warning systems can bring about positive impacts on clinical outcomes, but in paediatric practice, where the patient population is smaller and clinical outcomes event rates are low, alternative outcome measures are required to support research and quality improvement beyond large specialist centres, and methodological work on rare events is indicated. With investment in the development of alternative outcome measures and methodologies, programmes like PUMA could improve mortality and morbidity in paediatrics and other patient populations.

【 授权许可】

CC BY