title: Effect of a multifaceted intervention on documentation of vital signs and staff communication regarding deteriorating paediatric patients.
abstract: OBJECTIVE
  To evaluate the impact of newly designed Paediatric Early Warning Scores and an accompanying education package, COMPASS, on the frequency of documentation of vital signs and communication between health professionals and associated medical review in deteriorating paediatric patients.
  
  
  METHODS
  One thousand fifty-nine patients in the pre-intervention phase and 899 in the post-intervention phase were studied. The daily frequency of documentation of vital sign measurement, incidence of health professional communication and related medical reviews following clinical deterioration of a random subgroup of 262 pre-intervention and 221 post-intervention patients were studied in detail.
  
  
  RESULTS
  There were no significant differences in hospital mortality, medical emergency team reviews or unplanned admissions to critical care areas between the pre-intervention and post-intervention groups. There were significant increases in the post-intervention group for the median daily frequency of documentation of respiratory effort (0.0 (0-0) to 7.8 (5.8-12.6), P < 0.001), capillary refill (0 (0-0) to 1.1 (0-3.1), P < 0.001), blood pressure (0 (0-1.1) to 0 (0-1.6), P = 0.007) and level of consciousness (0 (0-0) to 7.8 (5.8-12.0), P < 0.001) and appropriate communication concerning patient deterioration 63 (8.5%) to 216 (40.9%), P < 0.001). There was a significant reduction in the number of children fulfilling the medical emergency team criteria (102 (38.9%) to 45 (20.4), P < 0.001).
  
  
  CONCLUSIONS
  A multifaceted intervention for the early recognition and response to clinical deterioration in children significantly improved documentation of vital signs, communication and time to medical review.
authors.affiliation: Performance and Innovation, ACT Government-Health, Woden, Australian Capital Territory, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: McKay
authors.forename: Imogen A
authors.initials: IA
authors.lastname: Mitchell
authors.forename: Kam
authors.initials: K
authors.lastname: Sinn
authors.forename: Heather
authors.initials: H
authors.lastname: Mugridge
authors.forename: Tony
authors.initials: T
authors.lastname: Lafferty
authors.forename: Chris
authors.initials: C
authors.lastname: Van Leuvan
authors.forename: Sarah
authors.initials: S
authors.lastname: Mamootil
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Abdel-Latif
mesh_terms: D001291:Attitude of Health Personnel; D020958:Australian Capital Territory; D002648:Child; D002675:Child, Preschool; D003142:Communication; D004282:Documentation / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D004496:Education, Continuing; D004630:Emergencies; D005260:Female; D019538:Health Care Surveys; D006305:Health Status Indicators; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007400:Interprofessional Relations; D008297:Male; D010348:Patient Care Team; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement / Q000706:statistics & numerical data; D062606:Tertiary Care Centers; D055986:Vital Signs