ArticleBMC health services research2022
Development, implementation and evaluation of an evidence-based paediatric early warning system improvement programme: the PUMA mixed methods study.
Article in BMC health services research, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Evaluating the Scale-Up and Sustainability of the Paediatric ESCALATION System in Country Western Australia: A Multi-Methods Study.The Australian journal of rural health · 2026Article
- Care Pathway and Outcomes in Pediatric Septic Shock: A Narrative Review from Emergency Department Recognition to PICU Management.Children (Basel, Switzerland) · 2026Review
- Recognising and responding to clinical deterioration in acute hospitals. Recording patient-reported wellness after Martha's rule.Frontiers in health services · 2026Article
- Criteria-based outpatient scheduling at a nephrology clinic: prospective evaluation of patient pre-assessment and its corresponding adaptive scheduling strategy.BMC health services research · 2024Article
- Do paediatric early warning systems reduce mortality and critical deterioration events among children? A systematic review and meta-analysis.Resuscitation plus · 2022Review
- Parents' experiences and perceptions of the acceptability of a whole-hospital, pro-active electronic pediatric early warning system (the DETECT study): A qualitative interview study.Frontiers in pediatrics · 2022Article
- Article
- Determinants of outcomes of childhood severe Malaria: A multi-centric study.Medical journal, Armed Forces IndiaArticle
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Authors and funding
21 authors.
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Abstract
backgroundPaediatric mortality rates in the United Kingdom are amongst the highest in Europe. Clinically missed deterioration is a contributory factor. Evidence to support any single intervention to address this problem is limited, but a cumulative body of research highlights the need for a systems approach.
methodsAn evidence-based, theoretically informed, paediatric early warning system improvement programme (PUMA Programme) was developed and implemented in two general hospitals (no onsite Paediatric Intensive Care Unit) and two tertiary hospitals (with onsite Paediatric Intensive Care Unit) in the United Kingdom. Designed to harness local expertise to implement contextually appropriate improvement initiatives, the PUMA Programme includes a propositional model of a paediatric early warning system, system assessment tools, guidance to support improvement initiatives and structured facilitation and support. Each hospital was evaluated using interrupted time series and qualitative case studies. The primary quantitative outcome was a composite metric (adverse events), representing the number of children monthly that experienced one of the following: mortality, cardiac arrest, respiratory arrest, unplanned admission to Paediatric Intensive Care Unit, or unplanned admission to Higher Dependency Unit. System changes were assessed qualitatively through observations of clinical practice and interviews with staff and parents. A qualitative evaluation of implementation processes was undertaken.
resultsAll sites assessed their paediatric early warning systems and identified areas for improvement. All made contextually appropriate system changes, despite implementation challenges. There was a decline in the adverse event rate trend in three sites; in one site where system wide changes were organisationally supported, the decline was significant (ß = -0.09 (95% CI: - 0.15, - 0.05); p = < 0.001). Changes in trends coincided with implementation of site-specific changes.
conclusionsSystem level change to improve paediatric early warning systems can bring about positive impacts on clinical outcomes, but in paediatric practice, where the patient population is smaller and clinical outcomes event rates are low, alternative outcome measures are required to support research and quality improvement beyond large specialist centres, and methodological work on rare events is indicated. With investment in the development of alternative outcome measures and methodologies, programmes like PUMA could improve mortality and morbidity in paediatrics and other patient populations.
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