​Bedside Paediatric Early Warning Systems (PEWS) do not significantly reduce mortality rates or clinical deterioration events in hospitalized pediatric patients, according to a March 13, 2018, article published in JAMA. Healthcare providers have hoped that the computerized early warning system would give hospitalized children a better chance of receiving timely and effective treatment when they experience clinical deterioration that their healthcare providers have not yet recognized. An accompanying editorial points out that the "failure of the BedsidePEWS intervention to positively reduce mortality rates may be difficult to reconcile with the expectation that outcomes can be improved if early clinical changes are identified." But the study also found that mortality rates were lower than the researchers initially expected, suggesting the early warning system might have proven effective had the number of mortalities been nearer the number researchers expected. The randomized trial collected data from 21 hospitals in seven countries from a pool of more than 140,000 patient discharges and nearly 600,000 patient-days over the course of about four years.

HRC Recommends: Prompt recognition and attention to patient deterioration are necessary for the patient to have a good outcome. Organizations must cultivate staff competencies in rapidly identifying conditions of concern. Practice (e.g., in simulations) and the use of tools (e.g., early-warning criteria) may aid speedy recognition. Clinicians can proactively assess patients' risk, plan for appropriate care and monitoring, educate at-risk patients, and supplement with technological monitoring. Organizations can develop condition-specific protocols for an organized and speedy response and analyze work systems and processes to identify and address barriers.