Development of an evidence-based ESCALATION system for recognition and response to paediatric clinical deterioration |
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| Affiliation: | 1. School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987 Perth, Western Australia 6845, Australia;2. Perth Children''s Hospital, Child & Adolescent Health Services, Western Australia, Australia;3. Kimberley Regional Paediatric Service, Broome Hospital, Western Australia, Australia;1. Member of the Australasian College for Emergency Medicine, Australia;2. Alice Springs Hospital, Gap Road, Alice Springs, Northern Territory, Australia;3. Honorary Academic Fellow, Baker Research Institute, Alice Springs, Northern Territory, Australia;4. Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Monash University, Melbourne, Australia;5. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;6. Centre for Integrated Critical Care, The University of Melbourne, Australia;7. Clinical Lecturer, School of Medicine, Flinders University, Australia;8. Clinical Lecturer, School of Public Health and Preventive Medicine, Monash University, Australia;1. Department of Intensive Care and Burn Center, University Hospital of Liège, Liège, Belgium;2. Public Health Department, Biostatistics, University of Liège, Sart-Tilman, Liège, Belgium;3. Department of Sport Sciences and Rehabilitation, University of Liège, Sart-Tilman, Liège, Belgium;1. Surgical and Translational Research (STaR) Centre, Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand;2. Department of Nutrition and Dietetics, Auckland City Hospital, Auckland, New Zealand;3. Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand;4. Department of General Surgery, Auckland City Hospital, Auckland, New Zealand;1. Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria, Australia;2. Monash Centre for Scholarship in Health Education (MCSHE), Monash University, Australia;1. Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan;2. Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School (Doorway 1), Edinburgh, UK;3. Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan;1. Monash Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia;2. School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, United Kingdom;3. School of Nursing and Health Professions, Federation University, Gippsland Campus, Churchill, VIC 3842, Australia |
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| Abstract: | AimThe aim of this study was to develop an evidence-based paediatric early warning system for infants and children that takes into consideration a variety of paediatric healthcare contexts and addresses barriers to escalation of care.MethodsA three-stage intervention development framework consisted of Stage 1: evidence review, benchmarking, stakeholder (health professionals, decision-makers, and health consumers) engagement, and consultation; Stage 2: planning and coproduction by the researchers and stakeholders using action research cycles; and Stage 3: prototyping and testing.ResultsA prototype evidence-based system incorporated human factor principles, used a structured approach to patient assessment, promoted situational awareness, and included family as well as clinician concern. Family involvement in detecting changes in their child's condition was supported by posters and flyers codesigned with health consumers. Five age-specific observation and response charts included 10 weighted variables and one unweighted variable (temperature) to convey a composite early warning score. The escalation pathway was supported by a targeted communication framework (iSoBAR NOW).ConclusionThe development process resulted in an agreed uniform ESCALATION system incorporating a whole-system approach to promote critical thinking, situational awareness for the early recognition of paediatric clinical deterioration as well as timely and effective escalation of care. Incorporating family involvement was a novel component of the system. |
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| Keywords: | Intervention development Clinical deterioration Paediatric Early warning system Early warning score |
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