Improved outcomes after successful implementation of a pediatric early warning system (PEWS) in a resource-limited pediatric oncology hospital

Cancer. 2017 Aug 1;123(15):2965-2974. doi: 10.1002/cncr.30664. Epub 2017 Apr 25.


Background: Hospitalized pediatric oncology patients are at high risk of clinical decline and mortality, particularly in resource-limited settings. Pediatric early warning systems (PEWS) aid in the early identification of clinical deterioration; however, there are limited data regarding their feasibility or impact in low-resource settings. This study describes the successful implementation of PEWS at the Unidad Nacional de Oncología Pediátrica (UNOP), a pediatric oncology hospital in Guatemala, resulting in improved inpatient outcomes.

Methods: A modified PEWS was implemented at UNOP with systems to track errors, transfers to a higher level of care, and high scores. A retrospective cohort study was used to evaluate clinical deterioration events in the year before and after PEWS implementation.

Results: After PEWS implementation at UNOP, there was 100% compliance with PEWS documentation and an error rate of <10%. Implementation resulted in 5 high PEWS per week, with 30% of patients transferring to a higher level of care. Among patients requiring transfer to the pediatric intensive care unit (PICU), 93% had an abnormal PEWS before transfer. The rate of clinical deterioration events decreased after PEWS implementation (9.3 vs 6.5 per 1000-hospitalpatient-days, p = .003). Despite an 18% increase in total hospital patient-days, PICU utilization for inpatient transfers decreased from 1376 to 1088 PICU patient-days per year (21% decrease; P<.001).

Conclusions: This study describes the successful implementation of PEWS in a pediatric oncology hospital in Guatemala, resulting in decreased inpatient clinical deterioration events and PICU utilization. This work demonstrates that PEWS is a feasible and effective quality improvement measure to improve hospital care for children with cancer in hospitals with limited resources. Cancer 2017;123:2965-74. © 2017 American Cancer Society.

Keywords: global health; pediatric early warning system (PEWS); pediatric intensive care; pediatric oncology; quality improvement.

MeSH terms

  • Adolescent
  • Algorithms*
  • Cancer Care Facilities*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Disease Progression
  • Early Diagnosis
  • Early Medical Intervention
  • Female
  • Guatemala
  • Health Resources*
  • Hospitals, Pediatric*
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Length of Stay
  • Male
  • Neoplasms / therapy*
  • Nursing Assessment*
  • Pneumonia / diagnosis*
  • Pneumonia / therapy
  • Quality Improvement
  • Retrospective Studies
  • Sepsis / diagnosis*
  • Sepsis / therapy
  • Shock, Septic / diagnosis
  • Shock, Septic / therapy
  • Vital Signs