ABSTRACT
Background: Establishing a paediatric early warning system in a paediatric Emergency Department (ED) is a complex process and more so with the COVID-19 pandemic. PUMA (PEWS Utilisation & Morality Avoidance) is a qualitative system assessment survey tool which assesses the strengths and weaknesses of the patient care safety processes and systems within a department1. This model draws together evidence from two theoretically informed systematic reviews1,2. Methods: The Sidra Medicine ED Quality group surveyed online 200 staff from the department of physicians/nursing team focussing on processes of monitoring patients and documentation, communication amongst the team and with parents, staff empowerment, situational awareness, escalation processes and response to the deteriorating child in the three broad domains of Detect, Prepare, and Act, with a further seven smaller domains (monitor, record, interpret, review, prepare, escalate, and evaluate) (Figure 1). Survey analysis enabled to review current practice, identify areas that are working well and areas for improvement. Results and implications: The online survey helped achieve a 85% return rate and identify seven areas for improvement in the system. The spider diagram (Figure 2) illustrates the areas of strength and weakness in the seven domains with respect to Detect, Prepare, and Act. We collaborated with the Cerner team, created an automatic documentation of vital signs from triage and treatment areas to the patient's Electronic Medical Record by associating patient's cardiac monitors to reduce manual errors and for the timely monitoring of vital signs. A one-day 'Back to Basics Training' refresher course for the nursing team was conducted. A senior nurse, as a watcher in the triage and treatment area, identified children at high risk of deterioration. A Pediatric ED Situational Awareness Tool (PEDSAT) was developed locally and is in trial to help manage sick children effectively. Conclusion: PUMA, a novel system assessment tool, empowered our ED to tailor a quality program with an aim to deliver effective and efficient patient care.
ABSTRACT
Background Establishing paediatric early warning system in a paediatric emergency department is a complex process and more so with COVID-19 pandemic. PUMA {PEWS Utilisation & Morality Avoidance} is a qualitative system assessment survey tool which assess the strengths and weaknesses of the patient care safety processes and systems within a department. 1 This model draws together evidence from two theoretically informed systematic reviews.1 2 Objectives To establish a Paediatric early warning system in the Sidra Paediatric Emergency Department Methods The Sidra Medicine ED Quality group surveyed online 200 staff in the department (physicians/nursing team) focussing on processes of monitoring patients and documentation, communication amongst the team and parents, staff empowerment, situational awareness, escalation processes and response to deteriorating child in the three broad domains of Detect, Prepare, and Act with further seven smaller domains (monitor, record, interpret, review, prepare, escalate and evaluate) (figure 1). Survey analysis enabled us to review our current practice, identify areas that are working well, and areas for improvement. Results The online survey platform helped us to achieve 85% return rate and to identify seven areas for improvement in our system. The spider diagram (Figure 2) illustrates the areas of strength and weakness in the seven domains of Detect, Prepare, and Act. We collaborated with Cerner team, created automatic documentation of vital signs from triage and treatment areas to patient Electronic Medical Record by associating patient's cardiac monitors to reduce manual errors and for the timely vitals monitoring. 'Back to Basics Training', a one day refresher course for nursing team has been conducted. A Senior Nurse as a watcher in the triage and treatment area identified children at high risk of deterioration. A Pediatric ED Situational Awareness Tool (PEDSAT) was developed locally and is in trial in the department to help manage sick children effectively. Conclusions PUMA, a novel system assessment tool empowered our emergency department to tailor a quality program with an aim to deliver effective and efficient patient care.