Resultados de la aplicación de una escala de alerta clínica precoz en pediatría como plan de mejora de calidad asistencial / Results of applying a paediatric early warning score system as a healthcare quality improvement plan

Objetivo. Introducir una escala de alerta clínica precoz en nuestra práctica habitual, evaluar su utilidad para prevenir el deterioro evitable en niños hospitalizados y capacitar al personal para comunicar la información y responder de forma efectiva. Material y métodos. Valoración de la aplicación de una escala de alerta clínica precoz incluida en la historia clínica electrónica, en pacientes hospitalizados de 0 a 15años (febrero 2014-septiembre 2014). La puntuación máxima era 6. Se requería evaluación del personal de enfermería cuando era >2 o conjunta médico-enfermera cuando era >3. Indicadores de seguimiento: porcentaje de pacientes con escala; porcentaje de registros completos; porcentaje de escalas >3; porcentaje de registros >3 con aviso al médico; porcentaje de cambios de tratamiento derivados del aviso y pacientes trasladados a la unidad de cuidados intensivos pediátricos (UCIP) o fallecimientos no detectados por la escala. Resultados. La escala se aplicó al 100% de pacientes ingresados (931), realizándose 7.917 tomas, con el 78,8% de registros completos. El 1,9% de las tomas fueron >3 y en el 70,5% se cumplió el aviso al médico. En el 14% de registros >3 se registró intensificación del tratamiento o solicitud de pruebas complementarias. Un paciente precisó traslado a UCIP (puntuación 2) y no hubo fallecimientos. La preocupación de los familiares/personal quedó registrada en el 80% de tomas. Conclusiones. Las escalas de alerta clínica precoz infantil permiten homogeneizar la monitorización, unificar formularios y mejorar los registros. La escasa aparición de complicaciones graves que requieran ingreso en UCIP y fallecimientos obligan a buscar otras variables de resultado para su evaluación (AU)

Objectives. The aims of this study were to introduce a paediatric early warning score (PEWS) into our daily clinical practice, as well as to evaluate its ability to detect clinical deterioration in children admitted, and to train nursing staff to communicate the information and response effectively. Material and methods. An analysis was performed on the implementation of PEWS in the electronic health records of children (0-15 years) in our paediatric ward from February 2014 to September 2014. The maximum score was 6. Nursing staff reviewed scores >2, and if >3 medical and nursing staff reviewed it. Monitoring indicators: % of admissions with scoring; % of complete data capture; % of scores >3; % of scores >3 reviewed by medical staff, % of changes in treatment due to the warning system, and number of patients who needed Paediatric Intensive Care Unit (PICU) admission, or died without an increased warning score. Results. The data were collected from all patients (931) admitted. The scale was measured 7,917 times, with 78.8% of them with complete data capture. Very few (1.9%) showed scores >3, and 14% of them with changes in clinical management (intensifying treatment or new diagnostic tests). One patient (scored 2) required PICU admission. There were no deaths. Parents or nursing staff concern was registered in 80% of cases. Conclusions. PEWS are useful to provide a standardised assessment of clinical status in the inpatient setting, using a unique scale and implementing data capture. Because of the lack of severe complications requiring PICU admission and deaths, we will have to use other data to evaluate these scales (AU)

[Results of applying a paediatric early warning score system as a healthcare quality improvement plan]. / Resultados de la aplicación de una escala de alerta clínica precoz en pediatría como plan de mejora de calidad asistencial.

OBJECTIVES: The aims of this study were to introduce a paediatric early warning score (PEWS) into our daily clinical practice, as well as to evaluate its ability to detect clinical deterioration in children admitted, and to train nursing staff to communicate the information and response effectively. MATERIAL AND METHODS: An analysis was performed on the implementation of PEWS in the electronic health records of children (0-15 years) in our paediatric ward from February 2014 to September 2014. The maximum score was 6. Nursing staff reviewed scores >2, and if >3 medical and nursing staff reviewed it. Monitoring indicators: % of admissions with scoring; % of complete data capture; % of scores >3; % of scores >3 reviewed by medical staff, % of changes in treatment due to the warning system, and number of patients who needed Paediatric Intensive Care Unit (PICU) admission, or died without an increased warning score. RESULTS: The data were collected from all patients (931) admitted. The scale was measured 7,917 times, with 78.8% of them with complete data capture. Very few (1.9%) showed scores >3, and 14% of them with changes in clinical management (intensifying treatment or new diagnostic tests). One patient (scored 2) required PICU admission. There were no deaths. Parents or nursing staff concern was registered in 80% of cases. CONCLUSIONS: PEWS are useful to provide a standardised assessment of clinical status in the inpatient setting, using a unique scale and implementing data capture. Because of the lack of severe complications requiring PICU admission and deaths, we will have to use other data to evaluate these scales.