533 - The COVID-19 Pandemic’s Impact on the Sustainability and Expansion of the Pediatric Early Warning System (PEWS) in Resource-Limited Hospitals

Poster Number: 533
Publication Number: 533.318

Parima P. Wiphatphumiprates, Rhodes College, Nashville, TN, United States; Dylan Graetz, St. Jude Children's Research Hospital, Memphis, TN, United States; Gia Ferrara, St. Jude Children's Research Hospital, Memphis, TN, United States; Maria F. Puerto-Torres, St Jude Children's Research Hospital, Byhalia, MS, United States; Srinithya R. Gillipelli, Baylor College of Medicine, Houston, TX, United States; Paul Elish, St. Jude Children's Research Hospital, Fort Collins, CO, United States; Hilmarie Muniz-Talavera, St Jude Childrens Research Hospital, Memphis, TN, United States; Alejandra Gonzalez-Ruiz, St. Jude Children's Research Hospital, Collierville, TN, United States; Miriam Armenta cruz, Hospital general tijuana, tijuana, Baja California, Mexico; Camila Barra, Hospital Dr Luis Calvo Mackenna, Santiago, Region Metropolitana, Chile; Zulma N. Carpio Mayma, Instituto Nacional de Enfermedades Neoplásicas - Perú, Lima, Lima, Peru; Cinthia J. Hernández, St. Jude Children's Research Hospital, Querétaro, Queretaro de Arteaga, Mexico; María Susana Juarez Tobias, Hospital Central Dr Ignacio Morones Prieto, San Luis Potosi, San Luis Potosi, Mexico; Jose Loeza, Centro Estatal de Cancerología del Estado de Veracruz, Xalapa, Veracruz-Llave, Mexico; Gladys M. Mendez, UNOP National Unit of Pediatric Oncology, Guatemala, Jutiapa, Guatemala; Erika Montalvo, SOLCA, Quito, Pichincha, Ecuador; Eulalia C. Penafiel, Instituto del Cancer Solca Cuenca, CUENCA, Azuay, Ecuador; Estuardo E. Pineda, Hospital Nacional de niños Benjamin Bloom, San Salvador, San Salvador, El Salvador; Virginia R. McKay, Washington University in St Louis, St. Louis, MO, United States; Asya Agulnik, St. Jude Children's Research Hospital, Memphis, TN, United States

Background: The COVID-19 pandemic impacted healthcare delivery worldwide, including pediatric cancer care, with a disproportionate effect in resource-limited settings. Although the pandemic highlighted multiple healthcare challenges, there is little research evaluating its impact on existing quality improvement programs.

Objective: To evaluate the impact of the pandemic on an existing quality improvement program to implement a Pediatric Early Warning System (PEWS) in pediatric oncology hospitals in Latin America.

Design/Methods: A qualitative study was conducted with 71 semi-structured interviews of clinical staff and hospital leaders in 5 pediatric oncology centers participating in a collaborative to implement PEWS in Latin America (Proyecto EVAT). An interview guide was created based on the Consolidated Framework for Implementation Research (CFIR). Interviews were conducted virtually in the summer of 2020, recorded, transcribed, and translated into English. A codebook was developed based on the CFIR and two coders independently coded all transcripts using MAXQDA, achieving a final kappa of 0.8-0.9. Thematic analysis was conducted to explore the impact of COVID-19 on the hospitals and their ability to continue or scale the PEWS program.

Results: Participants from all hospitals reported similar limitations in material resources, widespread healthcare staff reduction, and varying impacts on patient volumes because of the pandemic. However, the pandemic’s impact on PEWS varied across centers. Participants expressed that the availability of material resources for PEWS, staff turnover, PEWS training for staff, and the willingness of staff and hospital leaders to continue and promote PEWS were modifiers that either promoted or limited ongoing PEWS use (Figure 1, Table 3). Consequently, some hospitals were able to sustain PEWS; but others halted or reduced PEWS usage due to prioritization of other work. Similarly, the pandemic delayed plans at all hospitals to expand PEWS to other units or centers; although some did implement PEWS in their new COVID units. Several participants were hopeful for future expansion of PEWS.Conclusion(s): This is the first study evaluating the impact of the COVID-19 pandemic on an existing quality improvement program in resource-limited hospitals, revealing the pandemic created challenges in the sustainability and scale of PEWS. Several identified modifiers promoted ongoing use of PEWS despite these challenges, which can guide strategies to sustain quality improvement interventions during the current and future health crises.
Parima Prim Wiphatphumiprates CVParima Prim Wiphatphumiprates Resume.pdf
Table 3: Modifiers that Impact the Use of PEWS