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

Intensive Crit Care Nurs. 2015 Apr;31(2):91-9. doi: 10.1016/j.iccn.2014.01.001. Epub 2014 May 28.


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.

Keywords: Child; Deterioration; Emergency; PEW; PICU; Paediatric; Paediatric Early Warning; Pediatric; Unplanned admission to PICU.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Benchmarking
  • Child
  • Child Health Services
  • Child, Preschool
  • Cohort Studies
  • Emergencies / nursing*
  • Emergency Service, Hospital
  • England
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units, Pediatric
  • Length of Stay
  • Male
  • Patient Admission / standards
  • Patient Admission / statistics & numerical data*
  • Pediatric Nursing
  • Severity of Illness Index*
  • State Medicine