PUMA – Paediatric early warning system (PEWS): Utilisation and Mortality Avoidance.
A prospective, mixed methods, before and after study identifying the evidence base for the core components of an effective PEWS and the development of an implementation package for implementation and use in the UK.
Why is this study being done?
Research shows that identified that acute in-hospital deterioration is often preceded by a period of physiological instability which, when recognised, provides an opportunity for earlier intervention to improve outcome. A National Early Warning system to standardise the assessment of acute illness severity in adults has been implemented. A similar intervention may save lives in hospitalised children, but the evidence base for a national Paediatric Early Warning System is uncertain. Paediatric Track and trigger tools (PTTS) have developed in the UK in an ad hoc way, many based on consensus opinion, with limited evidence base or evaluation of effectiveness. Using PTTS is a complex intervention which involves the use a tool, underpinned by an organisational safety system/culture to identify and respond to patients flagged as at risk of deterioration.
Research Questions: What is the evidence for the core components of a national paediatric track and trigger tool? What is the evidence that the implementation of paediatric track and trigger tool in the UK NHS environment will reduce avoidable morbidity and mortality in hospitalised children? What are the (micro, meso and macro) contextual features consequential for its success? What factors are necessary to support successful implementation and normalisation?
Study Objectives: Identify through a systematic review of the literature the evidence for the core components of a paediatric track and trigger tool; Develop theories about the mechanisms by which they have their effects; Develop a track and trigger tool for use in different contexts; Develop an implementation package for prospective evaluation; Evaluate the ability of the track and trigger tool to impact on clinical outcomes Identify the contextual factors that are consequential for tool effectiveness; Develop evidence-based recommendations for a national PEWS with underpinning programme theories; Identify the key ingredients of successful implementation and normalisation.
Study design: Mixed methods study. 1: Systematic review of the evidence and tool development: The development of a track and trigger tool and an implementation manual based on systematic review and expert consultation 2: A prospective mixed method, before-and-after study design in four hospitals, with embedded case studies is proposed. These embedded case studies within the study at each phase will evaluate normal practice, the process of implementation and the use of the track and trigger tool post implementation. 1) Observe outcomes in current practice 2) Implement the system 3) Evaluate the system in use.
Chief Investigator(s) Professor Davina Allen
Co-investigators: Associate Professor Damian Roland, Dr (Elizabeth) Dawn Edwards, Dr Chao Huang, Dr David Lacy, Dr Emma Thomas-Jones, Dr Gerri Sefton, Dr James Bunn, Dr Lyvonne Tume, Ms Alison Oliver, Ms Jennifer Preston, Professor Kerenza Hood
Funder: NIHR HSDR £1,984,669.00