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Effect of a multifaceted intervention on documentation of vital signs and staff communication regarding deteriorating paediatric patients

Authors

  • Heather McKay,

    1. Performance and Innovation, ACT Government-Health, Woden, Australian Capital Territory, Australia
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  • Imogen A Mitchell,

    1. The Clinical School, Australian National University, Woden, Australian Capital Territory, Australia
    2. Department of Intensive Care, Canberra Hospital, Garran, Australian Capital Territory, Australia
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  • Kam Sinn,

    1. The Clinical School, Australian National University, Woden, Australian Capital Territory, Australia
    2. Department of Emergency, Canberra Hospital, Garran, Australian Capital Territory, Australia
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  • Heather Mugridge,

    1. Department of Paediatrics, Canberra Hospital, Garran, Australian Capital Territory, Australia
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  • Tony Lafferty,

    1. The Clinical School, Australian National University, Woden, Australian Capital Territory, Australia
    2. Department of Paediatrics, Canberra Hospital, Garran, Australian Capital Territory, Australia
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  • Chris Van Leuvan,

    1. Department of Anaesthetics, Canberra Hospital, Garran, Australian Capital Territory, Australia
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  • Sarah Mamootil,

    1. Performance and Innovation, ACT Government-Health, Woden, Australian Capital Territory, Australia
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  • Mohamed E Abdel-Latif

    Corresponding author
    1. The Clinical School, Australian National University, Woden, Australian Capital Territory, Australia
    2. Department of Neonatology, Canberra Hospital, Garran, Australian Capital Territory, Australia
    • Performance and Innovation, ACT Government-Health, Woden, Australian Capital Territory, Australia
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  • Conflict of interest: Nothing to declare.
  • Contributorship statement
  • The manuscript has been read and approved by all the authors (all of whom fulfilled the requirements for authorship), and each author believes that the manuscript represents an honest work. Detailed author contribution statement for this manuscript is attached.

Correspondence: Associate Professor Mohamed E Abdel-Latif, Department of Neonatology, The Australian National University Medical School, PO Box 11, Woden, ACT 2606, Australia. Fax: +61 2 6244 3112; email: abdel-latif.mohamed@act.gov.au

Abstract

Aim

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.

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