AUTHOR=Mirochnick Emily , Graetz Dylan E. , Ferrara Gia , Puerto-Torres Maria , Gillipelli Srinithya R. , Elish Paul , Muniz-Talavera Hilmarie  , Gonzalez-Ruiz Alejandra , Armenta Miriam , Barra Camila , Diaz-Coronado Rosdali , Hernandez Cinthia , Juarez Susana , Loeza Jose de Jesus , Mendez Alejandra , Montalvo Erika , Penafiel Eulalia , Pineda Estuardo , Agulnik Asya 

TITLE=Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

JOURNAL=Frontiers in Oncology

VOLUME=12

YEAR=2022

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1018224

DOI=10.3389/fonc.2022.1018224

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>Pediatric Early Warning Systems (PEWS) reduce clinical deterioration, improve interdisciplinary communication, and provide cost savings; however, little is known about how these impacts are achieved or related. This study evaluates the multi-level impacts of PEWS in resource-limited pediatric oncology centers.</p></sec><sec><title>Methods</title><p>We conducted 71 semi-structured interviews including physicians (45%), nurses (45%), and administrators (10%) from 5 resource-limited pediatric oncology centers in 4 Latin American countries. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed using <italic>a priori</italic> and inductively derived codes. Transcripts were independently coded by 2 coders, achieving a kappa of 0.8-0.9. Thematic content analysis explored perceived impacts of PEWS at the level of the <italic>patient</italic>, <italic>clinician</italic>, healthcare <italic>team</italic>, and <italic>institution</italic>.</p></sec><sec><title>Results</title><p>PEWS improved the quality of attention for <italic>patients</italic>, reducing morbidity and mortality. <italic>Clinicians</italic> felt more knowledgeable, confident, and empowered providing patient care, resulting in greater job satisfaction. PEWS affected <italic>team</italic> dynamics by improving interdisciplinary (ward and intensive care unit) and interprofessional (physicians and nurses) relationships and communication. This ultimately led to <italic>institutional</italic> culture change with emphasis on patient safety, collaboration with other centers, and receipt of institutional awards. Together, these impacts led to hospital-wide support of ongoing PEWS use.</p></sec><sec><title>Conclusions</title><p>In resource-limited hospitals, PEWS use results in multi-level positive impacts on <italic>patients</italic>, <italic>clinicians</italic>, <italic>teams</italic>, and <italic>institutions</italic>, creating a feedback loop that further supports ongoing PEWS use. These findings can guide advocacy for PEWS to various stakeholders, improve PEWS effectiveness, and inform assessment of other interventions to improve childhood cancer outcomes.</p></sec>