326 - Arriving Safely: Implementing Pediatric Early Warning Scores (PEWS) for Transported Patients

Poster Number: 326
Publication Number: 326.323

Hyungjoo Jeong, Inova Children's Hospital, Fairfax, VA, United States; Cynthia L. Gibson, Inova Children's Hospital, Falls Church, VA, United States; Courtney Port, Inova Children's Hospital, Falls Church, VA, United States

Background: Accurate inpatient placement for the level of care needed can be challenging, especially when the patient being transported from another facility has an illness in which the clinical status can change rapidly or the arrival is delayed due to distance traveled or unavailable transport crews. The Pediatric Early Warning Score (PEWS) system is useful for early recognition of clinical deterioration. 

Objective: We aimed to implement a PEWS system and escalation algorithm with 80% of incoming transported patients having PEWS completed during transport within 6 months.

Design/Methods: The Model for Improvement was utilized testing interventions through PDSA cycles. An escalation algorithm was created incorporating the PEWS scoring system (figure 1). Patient transport system (PTS) crews were taught the PEWS scoring system and the algorithm workflow expectations. Audit and feedback were used to increase the adoption of the process. Rapid escalation cases were reviewed by department leads to identify trends.

Results: PEWS score completion by PTS crews was initially 75% in the first four months following implementation (figure 2). After a pause in the project due to the COVID pandemic, the median had dropped to 50% but has since increased back to 75%. Completion rates varied by crew level of care (21%-78%) (figure 3). Despite the fluctuations in PEWS score completion, the percentage of transported patients requiring rapid escalation in care to the ICU or IMC within 24 hours remained low, below 3% (n=3-6) each quarter. Interestingly, 74% (n=14) of rapid escalations occur on night shift (7pm-7am) and 64% (n=9) of those occur after midnight; while 58% (n=11) are transferred for increased respiratory support needs and 32% (n=6) of transfers are for management and monitoring of neurologic issues, including status epilepticus and altered mental status.Conclusion(s): This project achieved improvement, but was not yet successful in reaching its goal. Notably, PTS crews reported feeling more empowered to speak up when a patient’s assessment was not as expected and improved communication with referral hospitals after implementing the PEWS scoring system and escalation algorithm. Next steps will include investigation of barriers by crew level of care and reviewing communication between sending and receiving providers.
Figure 1: The escalation algorithm created incorporating the PEWS scoring system.
Figure 2: The percentage over time of incoming transported patients for which the PTS crew completed PEWS scoring.Each data point contains data from 20 patient transfers. PTS = patient transport system. PEWS = pediatric early warning system. *Initial PDSA Cycle #1 with (9/1/2019-12/31/2019) is an average of 75% completion (Nf74). Break in data collection during COVID pandemic during the year 2020 and missing June 2021 PTS data.