title: What impact did a Paediatric Early Warning system have on emergency admissions to the paediatric intensive care unit? An observational cohort study.
abstract: The ideology underpinning Paediatric Early Warning systems (PEWs) is that earlier recognition of deteriorating in-patients would improve clinical outcomes.
  
  
  OBJECTIVE
  To explore how the introduction of PEWs at a tertiary children's hospital affects emergency admissions to the Paediatric Intensive Care Unit (PICU) and the impact on service delivery. To compare 'in-house' emergency admissions to PICU with 'external' admissions transferred from District General Hospitals (without PEWs).
  
  
  METHODS
  A before-and-after observational study August 2005-July 2006 (pre), August 2006-July 2007 (post) implementation of PEWs at the tertiary children's hospital.
  
  
  RESULTS
  The median Paediatric Index of Mortality (PIM2) reduced; 0.44 vs 0.60 (p<0.001). Fewer admissions required invasive ventilation 62.7% vs 75.2% (p=0.015) for a shorter median duration; four to two days. The median length of PICU stay reduced; five to three days (p=0.002). There was a non-significant reduction in mortality (p=0.47). There was no comparable improvement in outcome seen in external emergency admissions to PICU. A 39% reduction in emergency admission total beds days reduced cancellation of major elective surgical cases and refusal of external PICU referrals.
  
  
  CONCLUSIONS
  Following introduction of PEWs at a tertiary children's hospital PIM2 was reduced, patients required less PICU interventions and had a shorter length of stay. PICU service delivery improved.
authors.affiliation: PICU, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom. Electronic address: gerri.sefton@alderhey.nhs.uk.
authors.forename: G
authors.initials: G
authors.lastname: Sefton
authors.affiliation: PICU, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: McGrath
authors.affiliation: PICU, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, United Kingdom.
authors.forename: L
authors.initials: L
authors.lastname: Tume
authors.affiliation: University of Liverpool, Brownlow Hill, Liverpool L69 7ZX, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Lane
authors.affiliation: John Moores University, Byrom Street, Liverpool L3 3AF, United Kingdom.
authors.forename: P J G
authors.initials: PJ
authors.lastname: Lisboa
authors.affiliation: University of Liverpool, Brownlow Hill, Liverpool L69 7ZX, United Kingdom.
authors.forename: E D
authors.initials: ED
authors.lastname: Carrol
mesh_terms: D000293:Adolescent; D019985:Benchmarking; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D015331:Cohort Studies; D004630:Emergencies / Q000451:nursing*; D004636:Emergency Service, Hospital; D004739:England; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D010343:Patient Admission / Q000592:standards / Q000706:statistics & numerical data*; D010371:Pediatric Nursing; D012720:Severity of Illness Index; D013222:State Medicine
keywords: Child; Deterioration; Emergency; PEW; PICU; Paediatric; Paediatric Early Warning; Pediatric; Unplanned admission to PICU