Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme : the PUMA mixed methods study

Allen, D ORCID:, Lloyd, A, Edwards, D, Hood, K, Huang, C, Hughes, J, Jacob, N, Lacy, D, Moriarty, Y, Oliver, A, Preston, J, Sefton, G, Sinha, I, Skone, R, Strange, H, Taiyari, K, Thomas-Jones, E, Trubey, R, Tume, LN ORCID:, Powell, C and Roland, D 2022, 'Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme : the PUMA mixed methods study' , BMC Health Services Research, 22 (1) , p. 9.

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Background: Paediatric mortality rates in the United Kingdom are amongst the highest in Europe. Clinically missed deterioration is a contributory factor. Evidence to support any single intervention to address this problem is limited, but a cumulative body of research highlights the need for a systems approach. Methods: An evidence-based, theoretically informed, paediatric early warning system improvement programme (PUMA Programme) was developed and implemented in two general hospitals (no onsite Paediatric Intensive Care Unit) and two tertiary hospitals (with onsite Paediatric Intensive Care Unit) in the United Kingdom. Designed to har‑ ness local expertise to implement contextually appropriate improvement initiatives, the PUMA Programme includes a propositional model of a paediatric early warning system, system assessment tools, guidance to support improve‑ ment initiatives and structured facilitation and support. Each hospital was evaluated using interrupted time series and qualitative case studies. The primary quantitative out‑ come was a composite metric (adverse events), representing the number of children monthly that experienced one of the following: mortality, cardiac arrest, respiratory arrest, unplanned admission to Paediatric Intensive Care Unit, or unplanned admission to Higher Dependency Unit. System changes were assessed qualitatively through observations of clinical practice and interviews with staf and parents. A qualitative evaluation of implementation processes was undertaken. Results: All sites assessed their paediatric early warning systems and identifed areas for improvement. All made contextually appropriate system changes, despite implementation challenges. There was a decline in the adverse event rate trend in three sites; in one site where system wide changes were organisationally supported, the decline was signifcant (ß= -0.09 (95% CI: −0.15, −0.05); p=<0.001). Changes in trends coincided with implementation of site-specifc changes

Item Type: Article
Schools: Schools > School of Health and Society
Journal or Publication Title: BMC Health Services Research
Publisher: BioMed Central
ISSN: 1472-6963
Related URLs:
Funders: National Institute for Health Research (NIHR)
Depositing User: Dr Lyvonne Tume
Date Deposited: 06 Jan 2022 14:58
Last Modified: 15 Feb 2022 16:55

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