Multilevel impacts of a pediatric early warning system in resource-limited pediatric oncology hospitals

Emily, Mirochnick, Chicago Medical School; Dylan E, Graetz, St. Jude Children's Research Hospital; Gia, Ferrara, St. Jude Children's Research Hospital; Maria, Puerto-Torres, St. Jude Children's Research Hospital; Srinthya R, Gillipelli, St. Jude Children's Research Hospital; Paul, Elish, Emory University; Hilmaire, Muniz-Talavera, St. Jude Children's Research Hospital; Alejandra, Gonzalez-Ruiz, St. Jude Children's Research Hospital; Miriam, Armenta, Hospital General de Tijuana; Camila, Barra, Hospital Dr. Luis Calvo Mackenna Hospital; Rosdali, Diaz-Coronado, Instituto Nacional de Enfermedades Neoplasicas; Cinthia, Hernandez, Hospital Infantil Teletón de Oncología; Susana, Juarez, Hospital Central Dr. Ignacio Morines Prieto; Jose De Jesus, Loeza, Centro Estatal de Cancerología “Dr; Alejandra, Mendez, Unidad Nacional de Oncología Pediátrica; Erika, Montalvo, Hospital Oncológico Solca Núcleo de Quito; Eulalia, Penafiel, Instituto del Cáncer - SOLCA; Estuardo, Pineda, Hospital Nacional de Niños Benjamin Bloom; Asya, Agulnik, St. Jude Children's Research Hospital

Persistent URL

https://open.library.emory.edu/purl/68605qfvws-emory

Last modified

06/25/2025

Type of Material

Article

Authors

Emily Mirochnick, Chicago Medical School

Dylan E Graetz, St. Jude Children's Research Hospital

Gia Ferrara, St. Jude Children's Research Hospital

Maria Puerto-Torres, St. Jude Children's Research Hospital

Srinthya R Gillipelli, St. Jude Children's Research Hospital

Paul Elish, Emory UniversityHilmaire Muniz-Talavera, St. Jude Children's Research HospitalAlejandra Gonzalez-Ruiz, St. Jude Children's Research HospitalMiriam Armenta, Hospital General de TijuanaCamila Barra, Hospital Dr. Luis Calvo Mackenna HospitalRosdali Diaz-Coronado, Instituto Nacional de Enfermedades NeoplasicasCinthia Hernandez, Hospital Infantil Teletón de OncologíaSusana Juarez, Hospital Central Dr. Ignacio Morines PrietoJose De Jesus Loeza, Centro Estatal de Cancerología “DrAlejandra Mendez, Unidad Nacional de Oncología PediátricaErika Montalvo, Hospital Oncológico Solca Núcleo de QuitoEulalia Penafiel, Instituto del Cáncer - SOLCAEstuardo Pineda, Hospital Nacional de Niños Benjamin BloomAsya Agulnik, St. Jude Children's Research Hospital

Language

English

Date

2022-10-12

Publisher

Frontiers

Publication Version

Final Published Version

Copyright Statement

© 2022 Mirochnick, Graetz, Ferrara, Puerto-Torres, Gillipelli, Elish, Muniz-Talavera, Gonzalez-Ruiz, Armenta, Barra, Diaz-Coronado, Hernandez, Juarez, Loeza, Mendez, Montalvo, Penafiel, Pineda and Agulnik

License

Creative Commons Attribution 4.0 International

Final Published Version (URL)

http://dx.doi.org/10.3389/fonc.2022.1018224

Title of Journal or Parent Work

Frontiers in Oncology

Volume

12

Grant/Funding Information

EMi was supported by 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.
This study was funded by the American Lebanese-Syrian Associated Charities (ALSAC).

Supplemental Material (URL)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9597682/bin/DataSheet_1.docx

Abstract

Background: Pediatric Early Warning Systems (PEWS) reduce clinical deterioration, improve interdisciplinary communication, and provide cost savings; however, little is known about how these impacts are achieved or related. This study evaluates the multi-level impacts of PEWS in resource-limited pediatric oncology centers. Methods: We conducted 71 semi-structured interviews including physicians (45%), nurses (45%), and administrators (10%) from 5 resource-limited pediatric oncology centers in 4 Latin American countries. Interviews were conducted in Spanish, transcribed, and translated into English. A code book was developed using a priori and inductively derived codes. Transcripts were independently coded by 2 coders, achieving a kappa of 0.8-0.9. Thematic content analysis explored perceived impacts of PEWS at the level of the patient, clinician, healthcare team, and institution. Results: PEWS improved the quality of attention for patients, reducing morbidity and mortality. Clinicians felt more knowledgeable, confident, and empowered providing patient care, resulting in greater job satisfaction. PEWS affected team dynamics by improving interdisciplinary (ward and intensive care unit) and interprofessional (physicians and nurses) relationships and communication. This ultimately led to institutional culture change with emphasis on patient safety, collaboration with other centers, and receipt of institutional awards. Together, these impacts led to hospital-wide support of ongoing PEWS use. Conclusions: In resource-limited hospitals, PEWS use results in multi-level positive impacts on patients, clinicians, teams, and institutions, creating a feedback loop that further supports ongoing PEWS use. These findings can guide advocacy for PEWS to various stakeholders, improve PEWS effectiveness, and inform assessment of other interventions to improve childhood cancer outcomes.

Author Notes