Implementation of a pediatric early warning score tool in a pediatric oncology Ward in Palestine

Impact of Rapid Response Teams on Pediatric Care: An Interrupted Time Series Analysis of Unplanned PICU Admissions and Cardiac Arrests

Pediatric rapid response teams (RRTs) are expected to significantly lower pediatric mortality in healthcare settings. This study evaluates RRTs' effectiveness in decreasing cardiac arrests and unexpected Pediatric Intensive Care Unit (PICU) admissions. A quasi-experimental study (2014-2017) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, involved 3261 pediatric inpatients, split into pre-intervention (1604) and post-intervention (1657) groups. Baseline pediatric warning scores and monthly data on admissions, transfers, arrests, and mortality were analyzed pre- and post-intervention. Statistical methods including bootstrapping, segmented regression, and a Zero-Inflation Poisson model were employed to ensure a comprehensive evaluation of the intervention's impact. RRT was activated 471 times, primarily for respiratory distress (29.30%), sepsis (22.30%), clinical anxiety (13.80%), and hematological abnormalities (6.7%). Family concerns triggered 0.1% of activations. Post-RRT implementation, unplanned PICU admissions significantly reduced (RR = 0.552, 95% CI 0.485-0.628, p < 0.0001), and non-ICU cardiac arrests were eliminated (RR = 0). Patient care improvement was notable, with a -9.61 coefficient for PICU admissions (95% CI: -12.65 to -6.57, p < 0.001) and a -1.641 coefficient for non-ICU cardiac arrests (95% CI: -2.22 to -1.06, p < 0.001). Sensitivity analysis showed mixed results for PICU admissions, while zero-inflation Poisson analysis confirmed a reduction in non-ICU arrests. The deployment of pediatric RRTs is associated with fewer unexpected PICU admissions and non-ICU cardiopulmonary arrests, indicating improved PICU management. Further research using robust scientific methods is necessary to conclusively determine RRTs' clinical benefits.

The effectiveness of education strategies for nurses to recognise and manage clinical deterioration: A systematic review

OBJECTIVES

To identify, critically appraise and synthesise evidence on the efficacy of education strategies for nurses to recognise and manage clinical deterioration, as well as provide recommendations for standardised educational programmes.

DESIGN

A systematic review of quantitative studies.

METHODS

Quantitative studies published in English between 1 January 2010 and 14 February 2022 were chosen from nine databases. Studies were included if they reported education strategies for nurses to recognise and manage clinical deterioration. The quality appraisal was performed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project. The data were extracted and the findings were integrated into a narrative synthesis.

RESULTS

Altogether, 37 studies published in 39 eligible papers were included in this review, encompassing 3632 nurses. Most education strategies were determined to be effective, and outcome measures can be divided into three types: nurse outcomes; system outcomes; and patient outcomes. The education strategies could be divided into simulation and non-simulation interventions, and six interventions were in-situ simulations. Retention of knowledge and skills during the follow-up after education was determined in nine studies, with the longest follow-up interval totalling 12 months.

CONCLUSIONS

Education strategies can improve nurses' ability and practice to recognise and manage clinical deterioration. Simulation combined with a structured prebrief and debrief design can be viewed as a routine simulation procedure. Regular in-situ education determined long-term efficacy in response to clinical deterioration, and future studies can use an education framework to guide regular education practice and focus more on nurses' practice and patient outcomes.

Impact of an electronic alert system for pediatric sepsis screening a tertiary hospital experience

This study aimed to assess the potential impact of implementing an electronic alert system (EAS) for systemic inflammatory syndrome (SIRS) and sepsis in pediatric patients mortality. This retrospective study had a pre and post design. We enrolled patients aged ≤ 14 years who were diagnosed with sepsis/severe sepsis upon admission to the pediatric intensive care unit (PICU) of our tertiary hospital from January 2014 to December 2018. We implemented an EAS for the patients with SIRS/sepsis. The patients who met the inclusion criteria pre-EAS implementation comprised the control group, and the group post-EAS implementation was the experimental group. Mortality was the primary outcome, while length of stay (LOS) and mechanical ventilation in the first hour were the secondary outcomes. Of the 308 enrolled patients, 147 were in the pre-EAS group and 161 in the post-EAS group. In terms of mortality, 44 patients in the pre-EAS group and 28 in the post-EAS group died (p 0.011). The average LOS in the PICU was 7.9 days for the pre-EAS group and 6.8 days for the post-EAS group (p 0.442). Considering the EAS initiation time as the “zero time”, early recognition of SIRS and sepsis via the EAS led to faster treatment interventions in post-EAS group, which included fluid boluses with median (25th, 75th percentile) time of 107 (37, 218) min vs. 30 (11,112) min, p < 0.001) and time to initiate antimicrobial therapy median (25th, 75th percentile) of 170.5 (66,320) min vs. 131 (53,279) min, p 0.042). The difference in mechanical ventilation in the first hour of admission was not significant between the groups (25.17% vs. 24.22%, p 0.895). The implementation of the EAS resulted in a statistically significant reduction in the mortality rate among the patients admitted to the PICU in our study. An EAS can play an important role in saving lives and subsequent reduction in healthcare costs. Further enhancement of systematic screening is therefore highly recommended to improve the prognosis of pediatric SIRS and sepsis. The implementation of the EAS, warrants further validation in multicenter or national studies.