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Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals

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Last modified
  • 06/25/2025
Type of Material
Authors
    Farris Abutineh, St. Jude Children's Research HospitalDylan E Graetz, St. Jude Children's Research HospitalHilmarie Muniz-Talavera, St. Jude Children's Research HospitalGia Ferrara, St. Jude Children's Research HospitalMaria Puerto-Torres, St. Jude Children's Research HospitalYichen Chen, St. Jude Children's Research HospitalSrinthya R Gillipelli, Baylor College of MedicinePaul Elish, Emory UniversityAlejandra Gonzalez-Ruiz, Abt Associates, Inc.Yvania Alfonso Carreras, Hospital Saint-DamienShillel Alvarez, Benemérito Hospital General con Especialidades ¨Juan María de Salvatierra"Daniela Arce Cabrera, Hospital Pediátrico de SinaloaDeiby Arguello Vargas, Hospital Nacional de Niños Dr. Carlos Sáenz HerreraMiriam Armenta Cruz, Hospital General de TijuanaCamila Barra, Centro de Investigación Clínica Bradford HillPatricia Calderon Sotelo, Hospital Infantil Manuel de Jesus Rivera La MascotaZulma Carpio, Instituto Nacional de Enfermedades NeoplasicasMayra Chavez Rios, Hospital para el Niño PoblanoDaniela Covarrubias, Centro Estatal de OncologíaLucy de Leon Vasquez, Hospital Infantil Regional Universitario Dr Arturo GrullónRosdali Diaz Coronado, Instituto Nacional de Enfermedades NeoplasicasEver A Fing Soto, Hospital General de CelayaWendy Gomez-Garcia, Hospital Infantil Dr. Robert Reid CabralCinthia Hernandez, Hospital Infantil Teletón de OncologíaMaría Susana Juarez Tobias, Hospital Central Dr. Ignacio Morines PrietoEsmeralda Leon, Hospital Nacional Guillermo Almenara Irigoyen, EsSaludJose de Jesus Loeza Loeza Oliva, Centro Estatal de CancerologíaAlejandra Mendez, St. Jude Children's Research HospitalKenia Miller, Hospital del Niño “Jose Renan Esquivel”Erika Montalvo Cozar, Hospital Oncológico Solca Núcleo de QuitoNatalia del Carmen Negroe Ocampo, Hospital General O'HoranEulalia Penafiel, Instituto del Cáncer SOLCA CuencaEstuardo Pineda, Hospital Nacional de Niños Benjamín BloomLigia Rios, Hospital Nacional Edgardo Rebagliati Martins, EsSaludEsperanza Rodriguez Ordonez, Instituto Mexicano del Seguro SocialVeronica Soto Chavez, Hospital Civil de GuadalajaraMeenakshi Devidas, St. Jude Children's Research HospitalAsya Agulnik, St. Jude Children's Research Hospital
Language
  • English
Date
  • 2023-01-01
Publisher
  • Frontiers
Publication Version
Copyright Statement
  • © 2023 Abutineh, Graetz, Muniz-Talavera, Ferrara, Puerto-Torres, Chen, Gillipelli, Elish, Gonzalez-Ruiz, Alfonso Carreras, Alvarez, Arce Cabrera, Arguello Vargas, Armenta Cruz, Barra, Calderon Sotelo, Carpio, Chavez Rios, Covarrubias, de Leon Vasquez, Diaz Coronado, Fing Soto, Gomez-Garcia, Hernandez, Juarez Tobias, Leon, Loeza Oliva, Mendez, Miller, Montalvo Cozar, Negroe Ocampo, Penafiel, Pineda, Rios, Rodriguez Ordonez, Soto Chavez, Devidas and Agulnik
License
Final Published Version (URL)
Title of Journal or Parent Work
Volume
  • 13
Start Page
  • 1122355
End Page
  • 1122355
Grant/Funding Information
  • This study was funded by the American Lebanese-Syrian Associated Charities (ALSAC). AA was funded by the Conquer Cancer Foundation Global Oncology Young Investigator Award for this work. FA was funded through the St. Jude Children’s Research Hospital Pediatric Oncology Education Program via grant R25CA23944 from the National Cancer Institute. These funders were not involved in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Supplemental Material (URL)
Abstract
  • Background: Pediatric Early Warning Systems (PEWS) aid in identification of deterioration in hospitalized children with cancer but are underutilized in resource-limited settings. Proyecto EVAT is a multicenter quality improvement (QI) collaborative in Latin America to implement PEWS. This study investigates the relationship between hospital characteristics and time required for PEWS implementation. Methods: This convergent mixed-methods study included 23 Proyecto EVAT childhood cancer centers; 5 hospitals representing quick and slow implementers were selected for qualitative analysis. Semi-structured interviews were conducted with 71 stakeholders involved in PEWS implementation. Interviews were recorded, transcribed and translated to English, then coded using a priori and novel codes. Thematic content analysis explored the impact of hospital characteristics and QI experience on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time. Results: In both quantitative and qualitative analysis, material and human resources to support PEWS significantly impacted time to implementation. Lack of resources produced various obstacles that extended time necessary for centers to achieve successful implementation. Hospital characteristics, such as funding structure and type, influenced PEWS implementation time by determining their resource-availability. Prior hospital or implementation leader experience with QI, however, helped facilitate implementation by assisting implementers predict and overcome resource-related challenges. Conclusions: Hospital characteristics impact time required to implement PEWS in resource-limited childhood cancer centers; however, prior QI experience helps anticipate and adapt to resource challenges and more quickly implement PEWS. QI training should be a component of strategies to scale-up use of evidence-based interventions like PEWS in resource-limited settings.
Author Notes
Keywords
Research Categories
  • Health Sciences, Medicine and Surgery
  • Health Sciences, Oncology

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