Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America.

Autor:	Agulnik A; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Schmidt-Grimminger G; Brown School, Washington University, St. Louis, MO, United States., Ferrara G; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Puerto-Torres M; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Gillipelli SR; Baylor College of Medicine, Houston, TX, United States., Elish P; Rollins School of Public Health, Emory University, Atlanta, GA, United States., Muniz-Talavera H; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Gonzalez-Ruiz A; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., Armenta M; Pediatric Oncology, Hospital General de Tijuana, Tijuana, Mexico., Barra C; Pediatric Oncology, Hospital Dr. Luis Calvo Mackenna, Santiago, Chile., Diaz-Coronado R; Pediatric Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru., Hernandez C; Pediatric Oncology, Hospital Infantil Teletón de Oncología, Querétaro, Mexico., Juarez S; Pediatrics, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosí, Mexico., Loeza JJ; Pediatric Oncology, Centro Estatal de Cancerología, Xalapa, Mexico., Mendez A; Pediatric Critical Care, Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala., Montalvo E; Pediatric Critical Care, Hospital Oncológico Solca Núcleo de Quito, Quito, Ecuador., Penafiel E; Pediatric Oncology, Instituto del Cáncer SOLCA Cuenca, Cuenca, Ecuador., Pineda E; Pediatric Oncology, Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador., Graetz DE; Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States., McKay V; Brown School, Washington University, St. Louis, MO, United States.
Jazyk:	angličtina
Zdroj:	Frontiers in health services [Front Health Serv] 2022 Oct 31; Vol. 2, pp. 1004805. Date of Electronic Publication: 2022 Oct 31 (Print Publication: 2022).
DOI:	10.3389/frhs.2022.1004805
Abstrakt:	Background: Sustainability, or continued use of evidence-based interventions for long-term patient benefit, is the least studied aspect of implementation science. In this study, we evaluate sustainability of a Pediatric Early Warning System (PEWS), an evidence-based intervention to improve early identification of clinical deterioration in hospitalized children, in low-resource settings using the Clinical Capacity for Sustainability Framework (CCS). Methods: We conducted a secondary analysis of a qualitative study to identify barriers and enablers to PEWS implementation. Semi-structured interviews with PEWS implementation leaders and hospital directors at 5 Latin American pediatric oncology centers sustaining PEWS were conducted virtually in Spanish from June to August 2020. Interviews were recorded, professionally transcribed, and translated into English. Exploratory thematic content analysis yielded staff perceptions on PEWS sustainability. Coded segments were analyzed to identify participant perception about the current state and importance of sustaining PEWS, as well as sustainability successes and challenges. Identified sustainability determinants were mapped to the CCS to evaluate its applicability. Results: We interviewed 71 staff including physicians (45%), nurses (45%), and administrators (10%). Participants emphasized the importance of sustaining PEWS for continued patient benefits. Identified sustainability determinants included supportive leadership encouraging ongoing interest in PEWS, beneficial patient outcomes enhancing perceived value of PEWS, integrating PEWS into the routine of patient care, ongoing staff turnover creating training challenges, adequate material resources to promote PEWS use, and the COVID-19 pandemic. While most identified factors mapped to the CCS, COVID-19 emerged as an additional external sustainability challenge. Together, these challenges resulted in multiple impacts on PEWS sustainment, ranging from a small reduction in PEWS quality to complete disruption of PEWS use and subsequent loss of benefits to patients. Participants described several innovative strategies to address identified challenges and promote PEWS sustainability. Conclusion: This study describes clinician perspectives on sustainable implementation of evidence-based interventions in low-resource settings, including sustainability determinants and potential sustainability strategies. Identified factors mapped well to the CCS, however, external factors, such as the COVID pandemic, may additionally impact sustainability. This work highlights an urgent need for theoretically-driven, empirically-informed strategies to support sustainable implementation of evidence-based interventions in settings of all resource-levels. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2022 Agulnik, Schmidt-Grimminger, Ferrara, Puerto-Torres, Gillipelli, Elish, Muniz-Talavera, Gonzalez-Ruiz, Armenta, Barra, Diaz-Coronado, Hernandez, Juarez, Loeza, Mendez, Montalvo, Penafiel, Pineda, Graetz and McKay.)
Databáze:	MEDLINE
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