Improving Detection of Deterioration Using the Children’s Hospital Early Warning Score Tool

Abstract

Problem & Purpose: The project site is a 41-bed-pediatric progressive care unit (PPCU) at an urban tertiary hospital that cares for patients with a variety of diagnoses such as congenital heart disease, respiratory illnesses, and surgical cases. Pediatric Early Warning Scores (PEWS) are used to identify at-risk patients for critical deterioration. A rapid response is a situation in which an emergency healthcare team is called to respond to a patient showing signs of medical deterioration. Lengthy intensive care unit (ICU) stays often occur after a rapid response or arrest. Currently, this unit performs PEWS with vital signs. The Children’s Hospital Early Warning Score (CHEWS) is a validated tool developed for earlier detection of deterioration in pediatric patients with complex medical problems. The purpose of this quality improvement project was to implement and evaluate the effectiveness of the CHEWS with a response algorithm on a 41-bed pediatric progressive unit to promote early recognition critical deterioration. Methods: The CHEWS was performed with vital signs using a response algorithm, which was adapted by a multidisciplinary team at the project site prior to implementation. Two components, presence of cardiac disease and patients status post abdominal surgery less than 12 months of age were scored for in addition to the tool. Bedside nurses and providers were educated using a PowerPoint video, survey, and in-person training. Ten champions received one-on-one training to reinforce education. Data was collected by manual chart auditing and evaluated using run charts. Results: Utilization of the CHEWS ranged from 29-69% with an average of 38.5% during the 14-week period. There was no change in average monthly PICU transfers or arrests. There was a decrease of average rapid response calls from pre-implementation from 8 to 5.25 monthly calls. When CHEWS was elevated, 79% of the scores had a corresponding lower PEWS score. Conclusions: These results indicate that higher compliance is necessary to assess effects of CHEWS on PICU transfers, rapid response calls, and arrests. The CHEWS scoring higher than the PEWS is consistent with the literature that demonstrated PEWS scores being lower than CHEWS scores when scored simultaneously.