Page 2671 - Week 08 - Wednesday, 21 September 2022
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This work was informed by the CHS care of the deteriorating child working group, comprising of emergency, intensive care, paediatric, medical emergency team, and anaesthetics team members, which has been meeting to review key areas of policy and procedure. The primary purpose of this working group is to provide multidisciplinary expertise to support and monitor CHS practices for the early recognition, management and escalation of care for acutely unwell or deteriorating paediatric patients. This has included the working group’s review and discussion more broadly with clinicians on early warning systems, with consideration of case analyses and literature on alternative systems.
I recognise that the public discussion on this matter has been prompted by views shared by the president of the Australian Medical Association ACT branch that there are better systems than the one used in Canberra Hospital. There is no doubt that one challenge over recent years in this work has been the different views held by senior clinicians. However, I am assured by people with considerable experience in these settings, working in these settings, that early recognition of a deteriorating patient and the provision of prompt and appropriate responses are well embedded in practice in both our public hospitals in the ACT. Canberra Health Services has clear procedures in place to recognise early signs of deterioration, and escalation protocols in place across the service.
Paediatric early warning systems enable staff to escalate the care of a deteriorating child based on their heart rate, blood pressure, temperature, respiratory rate, oxygen saturation, levels of consciousness, as well as looking at the child’s specific condition. Paediatric patients have observations recorded on their paediatric early warning score, or PEWS charts.
PEWS functions as a multivariable track and trigger system, where vital signs are monitored and recorded at the bedside and a score is allocated to the vital signs. The individual scores are summed to a total PEWS, and this assists in the identification of deteriorating patients. But as I have said multiple times publicly, and Ms Castley has completely ignored, individual vital signs results can also trigger an escalation pathway for clinical review and management of the patient under the current system, as well as an increasing PEWS trend.
Frequency of observations and escalation are the key components of the early monitoring system that is currently in place. If a PEWS identifies deterioration, frequency of observations are increased to half hourly, or more frequently, depending on the needs of the patient. Frequency can also increase to continuous monitoring if required.
A 2019 systematic review by Trubey et al was published in the British Medical
Journal, looking at the validity and effectiveness of early warning systems and track and trigger tools for identifying and reducing clinical deterioration in hospitalised children. As part of the review, the validation research of 18 unique paediatric track and trigger tools was evaluated, which goes to the breadth of tools that are used internationally as part of monitoring the deterioration of children and adolescents in hospital settings.
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