Clinician Perspectives on Multilevel Impacts of Pediatric Early Warning Systems (PEWS) in Resource-Variable Hospitals

Amela Siječić^1*Alejandra Catalina Quesada-Stoner¹Sayeda Islam²Sara Malone²Maria Puerto Torres¹Adolfo Cardenas-Aguirre¹Kim Prewitt²Maria Do Ceu Borborema³Andreia Ribeiro Pereira Aguiar de Paula⁴Laura Lemos de Mendonça e Fontes⁵Silvio Fabio Torres⁶Leticia Aradi Andrade Sarmiento⁷Ever Fing Soto⁸Rosdali Diaz-Coronado⁹Yefry A. Aragón-Joya¹⁰Jose Miguel MIJARES TOBIAS¹¹Isidoro Tejocote Romero¹²NORMA ARACELI LOPEZ FACUNDO¹³Scheybi Teresa MIRALDA MENDEZ¹⁴Maria Sánchez-Martín¹⁵Daniela Arce Cabrera¹⁶Daniela María Velasquez Cabrera¹⁷Verónica Soto Chávez¹⁸Valentine Jimenez Antolinez¹⁹Erika Montalvo²⁰Bobbi Carothers²Dylan Graetz¹Carlos acuna²¹Douglas Luke²Virginia Mckay²Asya Agulnik^1*

• ¹St. Jude Children's Research Hospital, Memphis, United States
• ²Washington University in St. Louis, St. Louis, Missouri, United States
• ³Professor Fernando Figueira Institute of Integral Medicine (IMIP), Recife, Pernambuco, Brazil
• ⁴Hospital do Amor Barretos, Barretos, Brazil
• ⁵Hospital Martagão Gesteira, Salvador, Bahia, Brazil
• ⁶Hospital Universitario Austral, Buenos Aires, Buenos Aires, Argentina
• ⁷Servicio de hematología pediátrica, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, México, Mexico
• ⁸Hospital General Celaya, Celaya, Mexico
• ⁹Instituto Nacional de Enfermedades Neoplásicas (INEN), Lima, Peru
• ¹⁰National Cancer Institute (Colombia), Bogotá, Cundinamarca, Colombia
• ¹¹Hospital de Especialidades del Niño y la Mujer, Querétaro, Mexico
• ¹²Instituto Materno Infantil del Estado de México (IMIEM), Toluca, México, Mexico
• ¹³HOSPITAL MATERNO INFANTIL ISSEMYM, Toluca, Mexico
• ¹⁴HOSPITAL ESCUELA UNIVERSITARIO, Tegucigalpa, Honduras
• ¹⁵University Hospital La Paz, La Paz, Madrid, Spain
• ¹⁶Pediatric Hospital of Sinaloa, Culiacan, Sinaloa, Mexico
• ¹⁷Hospital Regional de Alta Especialidad del Bajío, Guanajuato, Guanajuato, Mexico
• ¹⁸Civil Hospital of Guadalajara, Guadalajara, Jalisco, Mexico
• ¹⁹Dr José Eleuterio Gonzalez University Hospital, Monterrey, Nuevo León4, Mexico
• ²⁰Hospital SOLCA Quito, Quito, Pichincha, Ecuador
• ²¹Hospital Luis Calvo Mackenna, Santiago, Santiago Metropolitan Region (RM), Chile

Pediatric Early Warning Systems (PEWS) are evidence-based interventions that monitor hospitalized pediatric patients to improve outcomes and prevent complications, particularly in children with cancer. However, there is limited data on how clinicians perceive the impact of PEWS on patient care across healthcare centers in resource-variable settings. Understanding clinicians' perceptions of PEWS is crucial, as their recognition of its benefits can enhance adoption and sustainability across various healthcare settings.Objective: To assess clinician perceptions of impacts following PEWS implementation across pediatric oncology centers in Latin America and Spain.We conducted a secondary analysis of a study assessing capacity for PEWS sustainability and adaptations at resource-variable hospitals participating in a collaborative to implement PEWS. Anonymous surveys in Spanish and Portuguese were distributed to nurses, physicians, ward, and ICU clinicians using PEWS at 58 hospitals across 19 countries. The survey included one freetext question about adaptations made to PEWS. A qualitative analysis of these responses was conducted using codes developed during a previous study to describe clinician perceptions on PEWS impact. Content analysis focused on clinician perspectives on the multilevel impact of PEWS.Of 1,909 free-text responses, PEWS impact was mentioned in 48% (n=913) by clinicians at 58 participating hospitals. Participants described impacts at the level of the patient, clinician, team, and institution, and emphasized the positive impact of PEWS at their centers. PEWS was perceived as vital in facilitating timely patient care interventions, mitigating progression of critical illness, and reducing mortality for pediatric oncology patients. Clinicians also reported that PEWS made patient care easier and empowered them in their roles. Finally, PEWS was perceived to improve communication and team dynamics among multidisciplinary clinicians.This study adds to existing literature by describing clinician perceptions of the multilevel impacts of PEWS on hospital care for children with cancer across hospitals of diverse resourcelevels, providing further evidence of how this intervention might benefit patients, clinicians, and clinical teams. These findings emphasize that understanding perspectives of clinicians who use evidence-based interventions, like PEWS is crucial to promote adoption and guide sustainability strategies to improve outcomes for children with cancer globally.