Description

The Dutch-Ambulance Pediatric Early Warning Score (DA-PEWS) system is a specialized clinical assessment tool designed to enhance pediatric care during ambulance transfers. Its primary function is to facilitate the early recognition of clinical deterioration in children, thereby improving outcomes through timely intervention.

Key Functions

• Standardized Communication: DA-PEWS standardizes communication and handovers within the pediatric care chain, ensuring clarity and consistency among healthcare providers.
• Structured Monitoring: Provides structured guidelines for monitoring vital signs, risk stratification, and decision-making regarding transport safety and team composition.

Core Features

• Vital Parameters Integration: Integrates vital parameters, patient responsiveness, and watcher/worried signs into risk categories to predict clinical deterioration.
• Consistent Layout: Maintains the same layout and scoring system as the hospital-based D-PEWS, with necessary adjustments for ambulance protocols.
• Age-Based Reference Ranges: Utilizes age-based reference ranges for vital signs to ensure accurate assessment.

Practical Tools

The system includes several practical tools to support its implementation:

• Pocket cards
• Instruction video
• Evaluation tools such as questionnaires and interview guides
• Transportation evaluation form for staff feedback

Intended Users

Designed for use by ambulance staff involved in pediatric interhospital transfers, particularly in medium complex (MC) and low complex (LC) ambulances. The inclusion criteria focus on cardiorespiratory stable patients aged 3–18 years, with specific exclusions to tailor its application effectively.

Implementation and Evaluation

The DA-PEWS system is supported by comprehensive training and ongoing evaluation through questionnaires and interviews at various intervals post-implementation. This evaluation spans both local and national ambulance services, with findings informing strategies for dissemination and scale-up.

Reported Benefits

• Improved Situational Awareness: Enhances risk stratification and quality of care.
• Uniform Communication: Increases uniformity in communication and handovers.
• Positive Feedback: Receives positive feedback on elements like the 'worried sign'.

Challenges and Solutions

Challenges include organizational variations, infrequent pediatric transfers, and registration issues. These are addressed through educational training and support tools like pocket cards.

Future Directions

The DA-PEWS system is considered suitable for broader implementation across other ambulance services, with further research needed to overcome barriers and evaluate national scalability. Its continued development aims to refine protocols and enhance pediatric care outcomes during ambulance transfers.