The Implementation of a Pediatric Early Warning System in Sidra Pediatric Emergency Department, Doha, Qatar

Background: Establishing a PEWS in a paediatric emergency department is a complex process. PUMA {Paediatric Early Warning System (PEWS): Utilisation & Morality Avoidance}, a qualitative system assessment survey tool which assess the strengths and weaknesses of the patient care safety processes and systems within a department. This model draws together evidence from two theoretically informed systematic reviews.

Objectives: To describe the implementation process of a PEWS in an emergency department

Methods: Sidra Emergency Department Quality group surveyed online 200 staff in the department (physicians and nursing team). Questionnaire focussed on processes of monitoring patients and documentation, communication amongst the team and parents, staff empowerment, situational awareness, escalation processes and response to deteriorating child in the three broad domains of Detect, Prepare and Act with further seven smaller domains of monitor, record, interpret, review, prepare, escalate and evaluate. Survey Analysis enabled us to review our current practice, identify areas that are working well and areas for improvement.

Results and implications: Use of online survey platform helped us to achieve 85% return rate. Analysis identified seven areas for improvement in our system. We addressed this by collaborating with Cerner team to integrate the monitors to Cerner in triage. Monitor association to patient Electronic Medical Record to reduce manual error and for the timely vitals monitoring. “Back to Basics Training”, one day refresher course for nursing team has been conducted. Senior Nurse as a watcher in the triage and treatment area to identify children at high risk of deterioration. A Pediatric Emergency Department Situational Awareness Tool (PEDSAT) was developed locally and is in trial in the department to help the team to manage sick children effectively.

Conclusion: PUMA, a novel system assessment tool empowered our emergency department to tailor a quality program with an aim to deliver effective and efficient patient care.