Overview of evidence on paediatric early warning response mechanisms
| Level of evidence | Type of study | Intervention | Availability | Composition | Activation criteria | Outcomes | Effectiveness | References |
|---|---|---|---|---|---|---|---|---|
| 2+well-conducted cohort study (n=2) | Cohort (n=2) | Paediatric RRT (n=1) Paediatric MET (n=1) Weekly insitu simulation team training (n=1) | 24 hours/7 days a week (n=11) Not reported (n=6) Activation by any staff member (n=10) Not reported (n=7) Activation by parent/family member (n=10) Not reported (n=11) RSS includes follow-up programme for all patients after PICU discharge (n=1) | 4 team members incl. PICU respiratory therapist, critical care nurse, PICU physician and hospital manager (n=1) Not reported (n=1) | Cardiovascular, respiratory and neurological changes, staff concern/worry (n=1) Not reported (n=1) | Clinical Cardiopulmonary arrest (n=2) Unplanned transfer to PICU (n=1) Mortality rates (n=1) Process MET/code blue activations (n=1) | Significant reduction in hospital mortality rates (n=2) Significant reduction in code rates (n=1) | 73 74 |
| 2- high risk of non-causal relationships/high risk of confounding or bias (n=9) | Interrupted time series (n=2) Cohort (n=4) Before and after (n=3) | RRS incl. MET and EWS (n=2) Paediatric RRT (n=2) RR calls (n=1) Paediatric MET (n=1) RRS using physician led MET (n=3) Follow-up 2 MET visits within 48 hours post PICU discharge (n=1) | 2 members incl. PICU respiratory therapist and critical care nurse (n=1) 3 team members (+PICU physician or paediatric resident) (n=5) 4 members (+paediatric critical care resident) (n=1) 9 members (+pharmacist, assistant residents, intern, security officer, chaplin) (n=1) Not reported (n=1) | Haemodynamic changes (n=1) Cardiovascular, respiratory and neurological changes (n=6), Staff concern/worry (n=5) Parent/family concern (n=4) Other—seizures (n=2), lethargy (n=1) Not reported (n=2) | Clinical Unplanned transfer to PICU (n=6) Mortality rates (n=5) Cardiac and/or respiratory arrest (CPA) (n=5) Interventions required (n=3) Process MET/code blue activations (n=7) Time from ICU transfer to life saving interventions (n=2) Time to transfer to ICU (n=1) Time of RR calls (n=2) Disposition of patient after RR call (n=1) MET assessment (activations and planned and unplanned visits) (n=1) | Reduction in cardiac and/or respiratory arrests but not significant (n=4) Reduction in death rates but not significant (n=2) No difference in CPA and/or mortality (n=1) No difference in mortality rates (n=2) Statistically significant more activations during day time (n=1) Mortality rate significantly higher for children transferred to PICU from acute care wards than other PICU admissions (n=1) | 54 55 60 64–68 81 | |
| 3 non-analytic case review (n=7) | Chart review (n=4) Database review (n=2) Case examples (n=1) | Paediatric RRT (n=2) Paediatric MET (n=3) Paediatric RRS (n=1) Paediatric Early Response Team (PERT) (n=1) Emergency Response Team (ERT) (n=1) | 1 member—PICU physician (n=1) 3 members incl. PICU respiratory therapist, critical care nurse and senior paediatric resident (n=1) 4–5 members (varied+charge nurse, manager, pharmacist) (n=5) | Cardiovascular changes (n=4) Respiratory and neurological changes (n=6), Staff concern/worry (n=6) Parent/family concern (n=5) Other—pain, agitation, seizures (n=1) Not reported (n=1) | Clinical Unplanned transfer to PICU (n=5) Cardiac and/or respiratory arrest (n=4) Mortality rates (n=2) Interventions required (n=2) Cardiac arrest (n=1) Process MET/code blue activations (n=7) Time from ICU transfer to life saving interventions (n=1) Time of RR calls (n=3) | Significant reduction in CPA (n=3) Significant reduction in mortality rates (n=3) Reduction in mortality rates but not significant (n=1) Risk of cardiac arrest and mortality decreased but not significant (n=1) No change in number of code blue calls (n=1) No change in mortality (n=1) Trend towards decreased frequency of PICU transfers (n=1) Unplanned admissions to PICU increased but not significant (n=1) Statistically significant more activations during day time (n=1) | 56 61 70 75 76 78 79 |