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Global pediatric PEWS study highlights variability in sustainment and the role of clinical capacity
Summary
Ginger McKay described Proyecto EVA (PEWS) — a cohort model across ~100 hospitals — finding variable sustainment: some hospitals sustain PEWS and others lapse requiring relaunch; adaptations occur but preliminary evidence suggests they often do not harm effectiveness. Prospective and qualitative work will probe determinants of sustainment.
Ginger McKay presented early results from Proyecto EVA, a multicountry effort to implement and study sustainment of Pediatric Early Warning Score (PEWS) interventions in roughly 100 hospitals across low‑resource settings.
McKay described PEWS as a nurse‑used bedside scoring tool and algorithm that prompts additional supportive care when thresholds are reached. Implementation occurs in phases: planning and pilot, wide‑scale implementation, early sustainability (close monitoring with St. Jude support), and full sustainability (reduced external support). The collaborative model enrolls 10–15 new hospitals each year and layers data collection across phases.
McKay said cross‑sectional and cohort data show not all clinicians or hospitals sustain PEWS consistently; hospitals may “bounce back” to high performance or may decline and need a relaunch. She reported that adaptations are common during sustainment but preliminary analyses suggest most adaptations have not undermined PEWS effectiveness. The project uses measures of clinical capacity as predictors of sustainment, translates measurement tools (CSAT) into Spanish and Portuguese for local validation, and will begin qualitative work (focus groups with nurses, doctors and administrators) to compare sustaining and non‑sustaining hospitals.
McKay emphasized practical design choices for global settings: reduce data collection burden, select minimal effectiveness indicators from patient records, and account for cultural and linguistic variability when adapting measurement tools. The team plans further analyses and a forthcoming paper on adaptations in the sustainment phase.
