Rapid review of the use of Paediatric Early Warning Systems in the UK

A diverse range of paediatric early warning (PEW) systems are commonly used across the UK, particularly in acute settings. A review of their use uncovered a growing interest amongst some healthcare decisionmakers in the potential of using a standardised system.

What is the issue?

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 introduced standardised national PEW systems, but England and Wales have not, leading to the use of different PEW systems in different locations.

How did we help?

RAND Europe was commissioned 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. We were also asked to note insights related to the standardisation of PEW systems and the de-implementation of old practices.

The researchers conducted a literature review that followed the principles of a rapid evidence assessment, complemented by a small number of interviews. Insights from this rapid review helped the researchers to understand the nature, prevalence and effectiveness of PEW systems, what influences the use of those PEW systems, and insights relating to the possible standardisation of PEW systems and de-implementation of existing systems.

What did we find?

  • A diverse range of PEW systems are commonly used across the UK, particularly in acute settings. There is some evidence that PEW systems can improve communication between healthcare staff, but evidence for their effectiveness in improving patient outcomes is limited.
  • 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. Standardisation may also help optimise resource use and enable shared learning about effective practice between different settings although there are some challenges in de-implementing existing PEW systems. Some of the factors that influence standardisation efforts include:

  • Early buy-in from staff
  • The ability to sustain engagement with standardisation over time
  • The ability to ensure the system has some adaptability to local settings