Table 2.
Data domain | Measures | Methods |
---|---|---|
Hospital Characteristics | Hospital type; funding; bed capacity; pediatric oncology and ICU staffing; annual volume of new diagnoses; and dates of PEWS adoption, training, pilot, and implementation completion. | • Collected at entry into Proyecto EVAT, confirmed by local site lead at study enrollment. |
Participant Demographics | 6 demographic questions on profession, role in PEWS implementation, years working in profession, gender, age, and hospital of employment. |
• Anonymous Spanish or Portuguese paper or electronic Qualtrics survey, requiring 10–15 min to complete. • Distributed to (estimated n = 27 per hospital): • PEWS implementation leadership team (nurses and physicians, mean n = 7, range 4–15). • Frontline clinical staff (all ward and ICU physicians and nurses using PEWS, mean n = 20, range 9–61). • Participants allowed 3 weeks to complete survey with 3 reminders. |
Clinical Capacity for Sustainability | CSAT: 7 domains with 5 questions (35 total), ranked on a 5-point Likert scale (1 = low to 5 = high agreement). Domain scores are the mean of domain items, and overall score is the mean of all domain scores; higher scores represent greater capacity. | |
PEWS Adaptation | 3 close-ended and 1 open-ended question on adaptations made to the PEWS scoring tool and algorithm [49]. Reported adaptations will be summed per respondent then averaged across all participants at each hospital. | |
PEWS Sustainment |
PEWS use and fidelity indicated by 3 types of errors (omission, scoring, and algorithm) in the 2 months before each CSAT data collection following implementation completion (sustainability phase). • Errors: (1) omissions (documented vital signs without using PEWS), (2) errors in PEWS scoring, and (3) PEWS algorithm nonadherence. • Dichotomous (yes/no < 15% in all three error types) and continuous (% errors). |
• Assess by the implementation team by reviewing nursing documentation of vital signs and PEWS in all hospitalized patients. • Assessed weekly during implementation until implementation completion. • Assessed for 2 months prior to survey assessment during the sustainability phase. • Submitted electronically. • Data aggregated to calculate monthly error %. |
Patient Outcomes |
• CDE: an unplanned transfer to a higher level of care (i.e., ICU), use of an ICU intervention on the ward (vasoactive infusion, invasive or noninvasive mechanical ventilation, or cardiopulmonary resuscitation), or a ward death in a patient without limitations on resuscitation [10]. • CDE mortality rate: percent of death occurring during event or within 24 h of event conclusion [10]. • Reported for 2 months before each CSAT data collection time point during sustainability phase. |
• Prospective de-identified registry of all CDEs in hospitalized pediatric oncology patients collected by the PEWS implementation team from start of participation in Proyecto EVAT. • For each CDE, a de-identified case report form is completed by local site leads and entered into a RedCAP database [50]. • Data analysis checks for missing and incorrect values assure data quality. |
Challenges to Capacity and Sustainability | Perspectives from hospital staff on challenges to capacity development, PEWS adaptation, and PEWS sustainability, as well as possible interventions to support sustainability. | • Focus groups of 5–7 physicians, nurses, and hospital administrators (3 focus groups per hospital) at 4 high- and 4 low-capacity hospitals as assessed by the CSAT. |