title: Implementing the Bedside Paediatric Early Warning System in a community hospital: A prospective observational study.
abstract: BACKGROUND
  Late transfer of children with critical illness from community hospitals undermines the advantages of community-based care. It was hypothesized that implementation of the Bedside Paediatric Early Warning System (Bedside PEWS) would reduce late transfers.
  
  
  METHODS
  A prospective before-and-after study was performed in a community hospital 22-bed inpatient paediatric ward. The primary outcome, significant clinical deterioration, was a composite measure of circulatory and respiratory support before transfer. Secondary outcomes were stat calls and resuscitation team calls, paediatrician workload and perceptions of frontline staff.
  
  
  RESULTS
  Care was evaluated for 842 patient-days before and 2350 patient-days after implementation. The median inpatient census was 13. Implementation of the Bedside PEWS was associated with fewer stat calls to paediatricians (22.6 versus 5.1 per 1000 patient-days; P<0.0001), fewer significant clinical deterioration events (2.4 versus 0.43 per 1000 patient-days; P=0.013), reduced apprehension when calling the physician and no change in paediatrician workload.
  
  
  CONCLUSIONS
  Implementation of the Bedside PEWS is feasible and safe, and may improve clinical outcomes.
authors.affiliation: Department of Critical Care Medicine;
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Parshuram
authors.forename: Ann
authors.initials: A
authors.lastname: Bayliss
authors.forename: Janette
authors.initials: J
authors.lastname: Reimer
authors.forename: Kristen
authors.initials: K
authors.lastname: Middaugh
authors.forename: Nadeene
authors.initials: N
authors.lastname: Blanchard