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Impact of PEWS on Pediatric Admissions

The document summarizes a study examining the impact of the Pediatric Early Warning Score (PEWS) assessment on the level of care for patients admitted from the emergency department with respiratory complaints. The study compared patients in the year before and after implementing PEWS assessments. It found that patients who received a PEWS assessment and scored 3 or higher had a lower rate of requiring an upgrade in care (0.88%) compared to both patients before PEWS was used (3.4%) and patients not assessed with PEWS after it was implemented (1.76%). The PEWS assessment was found to help identify patients in need of a higher level of care.

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50 views11 pages

Impact of PEWS on Pediatric Admissions

The document summarizes a study examining the impact of the Pediatric Early Warning Score (PEWS) assessment on the level of care for patients admitted from the emergency department with respiratory complaints. The study compared patients in the year before and after implementing PEWS assessments. It found that patients who received a PEWS assessment and scored 3 or higher had a lower rate of requiring an upgrade in care (0.88%) compared to both patients before PEWS was used (3.4%) and patients not assessed with PEWS after it was implemented (1.76%). The PEWS assessment was found to help identify patients in need of a higher level of care.

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latifahagustina
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Eric Higginbotham, MD, FAAP, FACEP

Associate Medical Director


Dell Children’s Medical Center Central Texas
Austin, Texas
 The Pediatric Early Warning Score
(PEWS) was developed in Canada to
quantify severity of illness in hospitalized
children1.
 It has not been studied as a risk
assessment tool in determining
admission level of care (LOC).
 Tostudy the impact of the ED PEWS
assessment of in-hospital level of care
upgrades in patients admitted from our
ED with respiratory complaints
 The PEWS was instituted as a standard
assessment after the attending
emergency physician (EP) made a
hospital admission decision for patients
with respiratory complaints, though it
was only applied when PEWS trained
nurses were in the department.
 A PEWS score of 3 or higher initiated a
discussion between the PEWS nurse and
the EP about admission LOC.
 We retrospectively created a database of
patients presenting with respiratory
complaints the year before and the year
after the institution of this policy.
 This created three cohorts: the Pre-PEWS
group (PPG); the PEWS group (PG); and
the No-PEWS group (NPG) (those in the
PEWS era for whom PEWS was not
assessed because the trained nurses
were not available).
 Ineach group, we analyzed the number
of admissions, the admission LOC (floor,
intermediate care unit and pediatric
intensive care unit) and the number of
LOC “upgrades” after admission.
 PPG (2008 CY)
• 9,476 patients with respiratory complaints
• 8,021 discharged from ED
• 1,198 admitted patients
• 239 eloped/AMA/UTL
• 41 upgrades in care
 Floor to IMC/PICU 33
 IMC to PICU 8
• 3.4% chance of upgrade in care
 Intervention period (2009 CY)
• 14,691 patients with respiratory complaints
• 12,723 discharged from ED
• 1,476 admitted patients
• 490 eloped/AMA/UTL
2 groups : PG, NPG
 PG
• 341 patients evaluated
• 3 upgrades in care (Floor to IMC/PICU)
• 0.88% chance of upgrade in care
 NPG
• 1,135 respiratory patients not evaluated with PEWS
• 20 upgrades in care (Floor to IMC/PICU or IMC to
PICU)
• 1.76% chance of upgrade in care
1. H. Duncan, J. Hutchinson, C.S.
Parshuram. The pediatric early warning
system score: A severity illness score to
predict urgent medical need in
hospitalized children. Journal of Critical
Care. 2006;21:271-279

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