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Abstract

Introduction: The pediatric early warning score (PEWS) was developed as a tool to identify hospitalized children who are likely to require resuscitation to treat cardiopulmonary arrest. Children transferred out of the pediatric intensive care unit (PICU) have higher risk for deterioration on the regular hospital floors. Methods: Upon placement of a transfer order, patients received a PEWS nursing assessment via the previously established PEWS scoring system. Patients then received subsequent scores at regular intervals based upon their initial assessment. Patient scores of 0-2 resulted in transfer out of the PICU without further intervention. A score of 3 required more frequent PEWS scoring prior to transfer. Scores of 4 or 5 resulted in further observation in the PICU, as well as a more extensive physician assessment and clearance prior to transfer to the floor. A score of 6 resulted in immediate physician assessment, and any score >6 resulted in immediate assessment and cancellation of transfer. All patients were required to have a physician/APN assessment within 1-hour of transfer. Nursing compliance with scoring was audited on a monthly basis. Feedback was then provided to any nurses failing to meet the protocol standards. Results: There were 1,888 total transfers out of the PICU in the year prior to the PEWS protocol, 25 of which were readmitted within 24 hours (1.3%). During the first year of PEWS initiation there were 1,958 total transfers, 18 of which were readmitted within 24 hours (0.9%)(X2=1.43, p<0.25). Conclusions: Contrary to our expectations, the PEWS protocol did not significantly reduce our 24-hour readmission rate. This may be because our pre-PEWS bounce back rate was extremely low (1.3%), lessening our overall impact for change. It may also indicate that PEWS is simply not universally applicable to all patient populations. Our PICU PEWS protocol could possibly be of some use in pediatric centers with significantly high 24-hour readmission rates. Expanding our data set to include more years prior to and after PEWS protocol initiation may have strengthened our results.