Challenges to Sustainability of Pediatric Early Warning System (Pews) in Resource-Limited Hospitals in Latin America

ABSTRACT

BACKGROUND AND AIM: Pediatric Early Warning Systems (PEWS) are evidence-based interventions that improve early identification of deterioration in resource-limited hospitals. While PEWS can be successfully implemented in these settings, little is known about their sustainability postimplementation. This study evaluates staff perspectives on the importance of, and challenges to, sustaining PEWS. METHOD(S) We conducted semi-structured interviews of PEWS implementation leaders and hospital directors at 5 pediatric oncology centers sustaining PEWS in Latin America. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed combining a priori and inductively derived codes. Transcripts were independently coded by 2 coders achieving a kappa of 0.8-0.9. Thematic content analyses explored staff perceptions on PEWS sustainability. RESULT(S) We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefit. However, participants reported a range of challenges sustaining PEWS, including fluctuations in human and material resources needed for PEWS, staff turnover and insufficient training, difficulty achieving new leadership buy-in, lack of internal systems to promote ongoing monitoring of PEWS, and the COVID-19 pandemic (Table 1). Together, these challenges resulted in multiple impacts, ranging from a small reduction in PEWS quality to complete disruption of PEWS use resulting in loss of benefits to patient outcomes in some units. CONCLUSION(S) While sustainability of evidence-based interventions like PEWS is valued by staff in resourcelimited hospitals, participants reported multiple challenges to sustainability resulting in reduced patient benefit. Future work should focus on identifying factors that promote intervention sustainability in these settings. (Table Presented).