Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals

• Published in: Frontiers in oncology Vol. 13; p. 1122355
• Main Authors: Abutineh, Farris, Graetz, Dylan E, Muniz-Talavera, Hilmarie, Ferrara, Gia, Puerto-Torres, Maria, Chen, Yichen, Gillipelli, Srinithya R, Elish, Paul, Gonzalez-Ruiz, Alejandra, Alfonso Carreras, Yvania, Alvarez, Shillel, Arce Cabrera, Daniela, Arguello Vargas, Deiby, Armenta Cruz, Miriam, Barra, Camila, Calderon Sotelo, Patricia, Carpio, Zulma, Chavez Rios, Mayra, Covarrubias, Daniela, de Leon Vasquez, Lucy, Diaz Coronado, Rosdali, Fing Soto, Ever Amilcar, Gomez-Garcia, Wendy, Hernandez, Cinthia, Juarez Tobias, María Susana, Leon, Esmeralda, Loeza Oliva, Jose de Jesus, Mendez, Alejandra, Miller, Kenia, Montalvo Cozar, Erika, Negroe Ocampo, Natalia Del Carmen, Penafiel, Eulalia, Pineda, Estuardo, Rios, Ligia, Rodriguez Ordonez, Esperanza, Soto Chavez, Veronica, Devidas, Meenakshi, Agulnik, Asya
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 03-05-2023
• Subjects: global health; implementation science; Oncology; Pediatric Early Warning Systems (PEWS); pediatric oncology; quality improvement collaborative (QIC); resource-limited settings; global health; resource-limited settings; pediatric oncology; quality improvement collaborative (QIC); Pediatric Early Warning Systems (PEWS); implementation science
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2023.1122355

Pediatric Early Warning Systems (PEWS) aid in identification of deterioration in hospitalized children with cancer but are underutilized in resource-limited settings. Proyecto EVAT is a multicenter quality improvement (QI) collaborative in Latin America to implement PEWS. This study investigates the relationship between hospital characteristics and time required for PEWS implementation.
This convergent mixed-methods study included 23 Proyecto EVAT childhood cancer centers; 5 hospitals representing quick and slow implementers were selected for qualitative analysis. Semi-structured interviews were conducted with 71 stakeholders involved in PEWS implementation. Interviews were recorded, transcribed and translated to English, then coded using
and novel codes. Thematic content analysis explored the impact of
and
on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time.
In both quantitative and qualitative analysis, material and human resources to support PEWS significantly impacted time to implementation. Lack of resources produced various obstacles that extended time necessary for centers to achieve successful implementation. Hospital characteristics, such as funding structure and type, influenced PEWS implementation time by determining their resource-availability. Prior hospital or implementation leader experience with QI, however, helped facilitate implementation by assisting implementers predict and overcome resource-related challenges.
Hospital characteristics impact time required to implement PEWS in resource-limited childhood cancer centers; however, prior QI experience helps anticipate and adapt to resource challenges and more quickly implement PEWS. QI training should be a component of strategies to scale-up use of evidence-based interventions like PEWS in resource-limited settings.