Accuracy and Efficiency of Recording Pediatric Early Warning Scores Using an Electronic Physiological Surveillance System Compared With Traditional Paper-Based Documentation.
Pediatric Early Warning Scores are advocated to assist health professionals to identify early signs of serious illness or deterioration in hospitalized children. Scores are derived from the weighting applied to recorded vital signs and clinical observations reflecting deviation from a predetermined "norm." Higher aggregate scores trigger an escalation in care aimed at preventing critical deterioration. Process errors made while recording these data, including plotting or calculation errors, have the potential to impede the reliability of the score. To test this hypothesis, we conducted a controlled study of documentation using five clinical vignettes. We measured the accuracy of vital sign recording, score calculation, and time taken to complete documentation using a handheld electronic physiological surveillance system, VitalPAC Pediatric, compared with traditional paper-based charts. We explored the user acceptability of both methods using a Web-based survey. Twenty-three staff participated in the controlled study. The electronic physiological surveillance system improved the accuracy of vital sign recording, 98.5% versus 85.6%, P < .02, Pediatric Early Warning Score calculation, 94.6% versus 55.7%, P < .02, and saved time, 68 versus 98 seconds, compared with paper-based documentation, P < .002. Twenty-nine staff completed the Web-based survey. They perceived that the electronic physiological surveillance system offered safety benefits by reducing human error while providing instant visibility of recorded data to the entire clinical team.
Author Affiliations: Pediatric Intensive Care Unit, Alder Hey Children's NHS Foundation Trust (Ms Sefton); and Institute of Translational Medicine (Dr Lane), and The Learning Clinic Ltd, 1 Sussex Place, London (Mr Killen); Faculty of Medicine, University of Liverpool, Liverpool (Mr Black, Mr Lyon, Ms Ampah, Ms Sproule, Mr Loren-Gosling, Ms Richards, Mr Spinty, Ms Holloway, Ms Davies, Ms Wilson, and Mr Chean); University of Central Lancashire, College of Health and Wellbeing, Preston, and Children's Nursing Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool (Ms Carter); and Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom (Dr Carrol).
Gerri
G
Sefton
Steven
S
Lane
Roger
R
Killen
Stuart
S
Black
Max
M
Lyon
Pearl
P
Ampah
Cathryn
C
Sproule
Dominic
D
Loren-Gosling
Caitlin
C
Richards
Jean
J
Spinty
Colette
C
Holloway
Coral
C
Davies
April
A
Wilson
Chung Shen
CS
Chean
Bernie
B
Carter
E D
ED
Carrol
D003936:Diagnosis, Computer-Assisted / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D004282:Documentation / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D004739:England; D006305:Health Status Indicators; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D011446:Prospective Studies; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013997:Time Factors; D055986:Vital Signs