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

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 ide...

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Autores principales: Agulnik, Asya, Schmidt-Grimminger, Gabriella, Ferrara, Gia, Puerto-Torres, Maria, Gillipelli, Srinithya R., Elish, Paul, Muniz-Talavera, Hilmarie, Gonzalez-Ruiz, Alejandra, Armenta, Miriam, Barra, Camila, Diaz-Coronado, Rosdali, Hernandez, Cinthia, Juarez, Susana, Loeza, Jose de Jesus, Mendez, Alejandra, Montalvo, Erika, Penafiel, Eulalia, Pineda, Estuardo, Graetz, Dylan E., McKay, Virginia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012640/
https://www.ncbi.nlm.nih.gov/pubmed/36925775
http://dx.doi.org/10.3389/frhs.2022.1004805
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author Agulnik, Asya
Schmidt-Grimminger, Gabriella
Ferrara, Gia
Puerto-Torres, Maria
Gillipelli, Srinithya R.
Elish, Paul
Muniz-Talavera, Hilmarie
Gonzalez-Ruiz, Alejandra
Armenta, Miriam
Barra, Camila
Diaz-Coronado, Rosdali
Hernandez, Cinthia
Juarez, Susana
Loeza, Jose de Jesus
Mendez, Alejandra
Montalvo, Erika
Penafiel, Eulalia
Pineda, Estuardo
Graetz, Dylan E.
McKay, Virginia
author_facet Agulnik, Asya
Schmidt-Grimminger, Gabriella
Ferrara, Gia
Puerto-Torres, Maria
Gillipelli, Srinithya R.
Elish, Paul
Muniz-Talavera, Hilmarie
Gonzalez-Ruiz, Alejandra
Armenta, Miriam
Barra, Camila
Diaz-Coronado, Rosdali
Hernandez, Cinthia
Juarez, Susana
Loeza, Jose de Jesus
Mendez, Alejandra
Montalvo, Erika
Penafiel, Eulalia
Pineda, Estuardo
Graetz, Dylan E.
McKay, Virginia
author_sort Agulnik, Asya
collection PubMed
description 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.
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spelling pubmed-100126402023-03-15 Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America Agulnik, Asya Schmidt-Grimminger, Gabriella Ferrara, Gia Puerto-Torres, Maria Gillipelli, Srinithya R. Elish, Paul Muniz-Talavera, Hilmarie Gonzalez-Ruiz, Alejandra Armenta, Miriam Barra, Camila Diaz-Coronado, Rosdali Hernandez, Cinthia Juarez, Susana Loeza, Jose de Jesus Mendez, Alejandra Montalvo, Erika Penafiel, Eulalia Pineda, Estuardo Graetz, Dylan E. McKay, Virginia Front Health Serv Health Services 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. Frontiers Media S.A. 2022-10-31 /pmc/articles/PMC10012640/ /pubmed/36925775 http://dx.doi.org/10.3389/frhs.2022.1004805 Text en 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. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Health Services
Agulnik, Asya
Schmidt-Grimminger, Gabriella
Ferrara, Gia
Puerto-Torres, Maria
Gillipelli, Srinithya R.
Elish, Paul
Muniz-Talavera, Hilmarie
Gonzalez-Ruiz, Alejandra
Armenta, Miriam
Barra, Camila
Diaz-Coronado, Rosdali
Hernandez, Cinthia
Juarez, Susana
Loeza, Jose de Jesus
Mendez, Alejandra
Montalvo, Erika
Penafiel, Eulalia
Pineda, Estuardo
Graetz, Dylan E.
McKay, Virginia
Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America
title Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America
title_full Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America
title_fullStr Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America
title_full_unstemmed Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America
title_short Challenges to sustainability of pediatric early warning systems (PEWS) in low-resource hospitals in Latin America
title_sort challenges to sustainability of pediatric early warning systems (pews) in low-resource hospitals in latin america
topic Health Services
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10012640/
https://www.ncbi.nlm.nih.gov/pubmed/36925775
http://dx.doi.org/10.3389/frhs.2022.1004805
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