A Quality Improvement Initiative to Reduce Unnecessary Rapid Responses Using Early Warning Scores.

Objectives: The Pediatric Early Warning Score (PEWS) is an evidence-based tool that allows early collaborative assessment and intervention for a rapid response team (RRT) activation. The goal of our quality improvement initiative was to reduce the percentage of unnecessary RRT activations by 50% over 2 years without increasing PICU transfers or compromising patient safety and timely evaluation.

Methods: A PEWS system replaced preexisting vital signs-based pediatric RRT criteria and was modified through plan-do-study-act cycles. Unnecessary RRT activations, total RRT activation rate, transfers to the PICU, total clinical interventions performed per RRT, and missed RRT activation rate were compared between intervention periods. Likert scale surveys were administered to measure satisfaction with each modification.

Results: There was a significant decrease in the percentage of unnecessary RRT activations from 33% to 3.5% after the implementation of the PEWS and modified-PEWS systems ( P < .05). The RRT activation rate decreased from 22.6 to 13.3 RRT activations per 1000 patient care days after implementation of the PEWS and modified-PEWS systems ( P < .05), without changes in PICU transfer rates. Physicians reported that the PEWS system improved nursing communication and accuracy of RRT criteria ( P < .05). Nursing reported that the PEWS system improved patient management and clinical autonomy ( P < .05).

Conclusions: The PEWS systems have been an effective means of identifying deteriorating pediatric patients and reducing unnecessary RRT activations. The new system fosters collaboration and communication at the bedside to prevent acute deterioration, perform timely interventions, and ultimately improve patient safety and outcomes.

Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose. The views expressed in this article are those of the authors and do not reflect the official policy or position of the US Army, the US Air Force, the US Department of Defense, or the US Government. Title 17 US Code 105 provides that “Copyright protection under this title is not available for any work of the United States Government.” Title 17 US Code 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person’s official duties.

(Copyright © 2021 by the American Academy of Pediatrics.)