Five Minute Consult

Michael Vossmeyer, MD
Director of general inpatient services
Cincinnati (OH)
Children's Hospital Medical Center

Cincinnati Children's implemented the Pediatric Early Warning Score with one goal: to reduce the number of cardiopulmonary arrests on its general medical units. After implementing PEWS, which quantifies a child's risk of clinical deterioration with a color-coded 13-point scale, the hospital has had only one code in nearly 1,100 days.

Vossmeyer: We were having a number of cardiopulmonary arrests on one of the general medical units. We thought these were preventable codes, because these kids showed signs of deterioration for a number of hours prior to the event. We did a very small test of change. We were looking for ease of use and any feedback from the front line. The nurses reported that it was easy to use and didn't interrupt workflow.

We mandated specific actions based on the kids' PEWS scores. At a particular score the bedside nurse had to notify the charge nurse. A point higher you had to call the intern. A point higher you called the senior resident, and a point higher you had to call the medical response team.

There was a lot of pushback initially that this was a lot of work. But what happens is over time they started to see the outcomes change. We had to start small to understand how it works in the environment and show it is a workable system.

—Carrie Vaughan