Center for Safety Research

Overview

Late detection of clinical deterioration in hospitalized children results in near and actual cardiopulmonary arrest.

BedsidePEWS is documentation-based system is the best available of care to identify children at risk of clinical deterioration. Implementation of BedsidePEWS should prevent these crises.

Objective

Evaluating the impact of BedsidePEWS on early identification of children at risk for near and actual cardiopulmonary arrest, hospital mortality, processes of care and PICU resource utilization.

Project

Implementation of the BedsidePEWS was compared with usual care in a cluster-randomized trial.

Data from 21 hospitals, 144539 hospital discharges, and 559,443 patient-days – making EPOCH the largest randomized trial of hospitalized children.

Findings

1. Documentation was significantly improved with BedsidePEWS
2. Late ICU admission was reduced with BedsidePEWS (p=0.03)
3. Mortality was not significantly different (p=0.96)
4. Hospital mortality was 40% of that anticipated at the start of the trial

Dissemination

• Published in JAMA 2018. 
• Concurrent Presentation SCCM. Late Breaker AHA.
• Editorialized in JAMA – and commentary in Journal Watch