Diverse paediatric early warning (PEW) systems are used in acute healthcare settings in the UK, to help staff identify early signs of clinical deterioration in patients and facilitate timely intervention. The Healthcare Improvement Studies commissioned RAND Europe to conduct a rapid review of the evidence on the use of UK PEW scores and systems and to identify learning relevant for potential efforts to standardise practice.

Cover: Paediatric Early Warning Systems: a scoping study
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Paediatric Early Warning Systems: a scoping study

Lessons from a rapid review

by Sarah Ball, Sarah Parkinson, Sonja Marjanovic

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Research Questions

  1. What are PEW scores and systems, how prevalent is their use and how do they vary in nature and effectiveness?
  2. What are the influences on the implementation and effective use of PEW scores and systems (including those related to the features of the scores and systems themselves and those related to the wider social, cultural and organisational context)?
  3. What are the key insights relating to the standardisation of PEW scores and systems, as well as the de-implementation of existing scores and systems?

Paediatric early warning (PEW) systems are widely used in acute paediatric healthcare settings to help healthcare staff identify early signs of clinical deterioration in patients and facilitate timely intervention. They use pre-specified alert criteria intended to trigger additional care when needed, monitored through observation charts. Northern Ireland and Scotland have standardised national PEW systems, but England and Wales do not, leading to the use of different PEW systems in different locations. RAND Europe was asked by The Healthcare Improvement Studies (THIS) Institute at Cambridge University to conduct a rapid review of the evidence relating to the use of PEW scores and systems in the UK. It was also asked, as far as possible, to note insights related to the standardisation of PEW systems and the de-implementation of old practices. The findings of this report are based on a literature review that followed the principles of a rapid evidence assessment, complemented by a small number of interviews. Insights from this scoping study are intended to inform potential future research into the process of de-implementing existing practices and services in healthcare.

Key Findings

  • A diverse range of PEW systems are commonly used across the UK, particularly in acute settings. The evidence base on their effectiveness in improving patient outcomes is limited but there is some evidence for benefits in terms of improving communication between healthcare staff and for staff empowerment.
  • There are a variety of influences on the use of PEW scores and systems. These include not only the features of the PEW systems themselves, such as their complexity, predictive validity and adaptability, but also the wider cultural and organisational context. Factors encouraging implementation of PEW systems include, amongst others, early engagement of staff in safety culture, appropriate staff training and supervision, the availability of sufficient staff and a range of standardised processes to support staff awareness.
  • There is a growing interest amongst some healthcare decisionmakers in the potential of using a standardised PEW system. This is in part due to dissatisfaction with existing approaches and a concern about the ability to effectively use differing systems when healthcare staff and patients move between hospitals. Standardisation may also help optimise resource use and enable shared learning about effective practice between different settings. Early buy-in from staff, the ability to sustain engagement with standardisation over time and the ability to ensure the system has some adaptability to local settings are some of the factors that influence standardisation efforts. De-implementation of incumbent PEW systems can be challenging and needs to be considered as part of efforts and plans to standardise a PEW system.

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This research was commissioned by The Healthcare Improvement Studies Institute (THIS Institute) and conducted by RAND Europe.

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