ArticleBMJ open2021
Reliability and validity of a Spanish-language measure assessing clinical capacity to sustain Paediatric Early Warning Systems (PEWS) in resource-limited hospitals.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 21 citations in OpenAlex.
- Sustainability and normalization of an intervention to improve evidence-based myocardial infarction care in Tanzania.Implementation science communications · 2026Article
- Strategies to improve healthcare team communication structure and quality in resource-variable childhood cancer hospitals (TeamTalk): a study protocol.Implementation science communications · 2025Article
- Sustainability and normalization of an intervention to improve evidence-based myocardial infarction care in Tanzania.Research square · 2025Article
- Documenting adaptations to an evidence-based intervention in 58 resource-variable pediatric oncology hospitals across implementation phases.Implementation science communications · 2024Article
- Lowering the burden: Shorter versions of the Program Sustainability Assessment Tool (PSAT) and Clinical Sustainability Assessment Tool (CSAT).Implementation science communications · 2024Article
- Connecting Clinical Capacity and Intervention Sustainability in Resource-Variable Pediatric Oncology Centers in Latin America.Global implementation research and applications · 2024Article
- Assessment of the quality of interdisciplinary communication (CritCom): evaluation and refinement of a center summary report.Frontiers in oncology · 2024Article
- Sustainability determinants of an intervention to identify clinical deterioration and improve childhood cancer survival in Latin American hospitals: the INSPIRE study protocol.Implementation science communications · 2023Article
- Effect of paediatric early warning systems (PEWS) implementation on clinical deterioration event mortality among children with cancer in resource-limited hospitals in Latin America: a prospective, multicentre cohort study.The Lancet. Oncology · 2023Article
- Development and pilot testing of PROACTIVE: A pediatric onco-critical care capacity and quality assessment tool for resource-limited settings.Cancer medicine · 2023Article
- Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals.Frontiers in oncology · 2023Article
- Article
- Assessment of Barriers and Enablers to Implementation of a Pediatric Early Warning System in Resource-Limited Settings.JAMA network open · 2022Article
- Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals.Frontiers in oncology · 2022Article
- Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America.Frontiers in health services · 2022Article
- Sustainability in pediatric hospitals: An exploration at the intersection of quality improvement and implementation science.Frontiers in health services · 2022Article
- Assessing the sustainability capacity of evidence-based programs in community and health settings.Frontiers in health services · 2022Article
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Authors and funding
26 authors at 6 institutions in 5 countries.
Funding
Abstract
backgroundPaediatric Early Warning Systems (PEWSs) improve identification of deterioration, however, their sustainability has not been studied. Sustainability is critical to maximise impact of interventions like PEWS, particularly in low-resource settings. This study establishes the reliability and validity of a Spanish-language Clinical Sustainability Assessment Tool (CSAT) to assess clinical capacity to sustain interventions in resource-limited hospitals.
methodsParticipants included PEWS implementation leadership teams of 29 paediatric cancer centres in Latin America involved in a collaborative to implement PEWS. The CSAT, a sustainability assessment tool validated in high-resource settings, was translated into Spanish and distributed to participants as an anonymous electronic survey. Psychometric, confirmatory factor analysis (CFA), and multivariate analyses were preformed to assess reliability, structure and initial validity. Focus groups were conducted after participants reviewed CSAT reports to assess their interpretation and utility.
resultsThe CSAT survey achieved an 80% response rate (n=169) with a mean score of 4.4 (of 5; 3.8-4.8 among centres). The CSAT had good reliability with an average internal consistency of 0.77 (95% CI 0.71 to 0.81); and CFAs supported the seven-domain structure. CSAT results were associated with respondents' perceptions of the evidence for PEWS, its implementation and use in their centre, and their assessment of the hospital culture and implementation climate. The mean CSAT score was higher among respondents at centres with longer time using PEWS (p<0.001). Focus group participants noted the CSAT report helped assess their centre's clinical capacity to sustain PEWS and provided constructive feedback for improvement.
conclusionsWe present information supporting the reliability and validity of the CSAT tool, the first Spanish-language instrument to assess clinical capacity to sustain evidence-based interventions in hospitals of variable resource levels. This assessment demonstrates a high capacity to sustain PEWS in these resource-limited centres with improvement over time from PEWS implementation.
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