Children's hospital care teams deal with pediatric codes every day. The unfortunate reality is the outcomes following a pediatric code are often poor. However, that many codes related to cardiac arrest may be preventable.
During a virtual featured session sponsored by Philips as part of Becker's Hospital Review 11th Annual Meeting in May, sponsored by Philips, two experts shared how Children's Hospital of Georgia in Augusta is identifying patient deterioration earlier thanks to the automation of Pediatric Earning Warning Scores (PEWS). The speakers were:
- Renuka Mehta, MD, professor in the department of pediatrics; associate residence program director; medical director at Children's Hospital of Georgia
- Hasan Zaidi, senior manager, client results and long-term strategic partnerships, Philips
Three key takeaways:
1. Early identification of symptoms is the key to preventing pediatric cardiopulmonary arrest. When children experience cardiac arrest in the hospital setting, most do not survive. However, many of these patients often exhibit abnormal physiological parameters in the hours before the event. "To prevent pediatric cardiopulmonary arrest, clinicians must first recognize that the patient is deteriorating," Dr. Mehta said. "However, providers have different levels of experience and they may not always recognize the acuity of patient illness in a timely fashion."
2. PEWS is an objective assessment tool that detects deterioration in children at risk of cardiac arrest. PEWS was first developed in the U.K. and modified by Cincinnati Children's Hospital to focus on three areas: 1) the central nervous system; 2) the cardiovascular system and 3) the respiratory system. If children at risk of cardiac arrest are identified early, their illness can be prevented.
In 2012, CHOG developed a PEWS card, implemented the protocol for calling the rapid response team and trained nurses, respiratory therapists and physicians. One of the challenges with PEWS, however, is that pediatric patients range in age from zero to 21 years old and normal vital signs vary with age. A normal heart rate in an infant, for example, could be abnormal in an adolescent.
3. Automated documentation and calculation of PEWS improves detection of deterioration. Initially, CHOG care providers manually documented the PEWS inputs and then the EHR calculated the scores. This generated additional work for care providers and led to lower provider satisfaction. In addition, some cases of pediatric cardiac arrest still went undetected.
In August 2018, CHOG automated PEWS by using Philips' IntelliVue Guardian software. Nurses or patient care technicians scan the patient's vitals and data is automatically sent to the patient record where PEWS is calculated. If a problem is detected, nurses follow the appropriate protocol.
This approach has worked well. "The pediatric medicine and the surgery units saw similar reductions in PEWS inaccuracy — in the range of 75 percent," Mr. Zaidi said. "This was the result of taking subjectivity out of the PEWS calculation and ensuring that scores were aligned from a unit perspective." Surveys of providers also found high levels of satisfaction in terms of usability, time savings and the ability to detect patient deterioration.
Results from case studies are not predictive of results in other cases. Results in other cases may vary.
To view this session on-demand, click here.