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. 2023 May 3:13:1122355.
doi: 10.3389/fonc.2023.1122355. eCollection 2023.

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

Farris Abutineh  1 , Dylan E Graetz  1 , Hilmarie Muniz-Talavera  1 , Gia Ferrara  1 , Maria Puerto-Torres  1 , Yichen Chen  1 , Srinithya R Gillipelli  2 , Paul Elish  3 , Alejandra Gonzalez-Ruiz  4 , Yvania Alfonso Carreras  5 , Shillel Alvarez  6 , Daniela Arce Cabrera  7 , Deiby Arguello Vargas  8 , Miriam Armenta Cruz  9 , Camila Barra  10 , Patricia Calderon Sotelo  11 , Zulma Carpio  12 , Mayra Chavez Rios  13 , Daniela Covarrubias  14 , Lucy de Leon Vasquez  15 , Rosdali Diaz Coronado  12 , Ever Amilcar Fing Soto  16 , Wendy Gomez-Garcia  17 , Cinthia Hernandez  18 , María Susana Juarez Tobias  19 , Esmeralda Leon  20 , Jose de Jesus Loeza Oliva  21 , Alejandra Mendez  1 , Kenia Miller  22 , Erika Montalvo Cozar  23 , Natalia Del Carmen Negroe Ocampo  24 , Eulalia Penafiel  25 , Estuardo Pineda  26 , Ligia Rios  27 , Esperanza Rodriguez Ordonez  28 , Veronica Soto Chavez  29 , Meenakshi Devidas  1 , Asya Agulnik  1
Affiliations

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

Farris Abutineh et al. Front Oncol. .

Abstract

Background: 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.

Methods: 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 a priori and novel codes. Thematic content analysis explored the impact of hospital characteristics and QI experience on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time.

Results: 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.

Conclusions: 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.

Keywords: Pediatric Early Warning Systems (PEWS); global health; implementation science; pediatric oncology; quality improvement collaborative (QIC); resource-limited settings.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
During implementation of Pediatric Early Warning Systems (PEWS), hospital characteristics such as funding structure and type impact resource availability, which in turn influences time required to implement PEWS. A hospital’s experience with Quality Improvement (QI) can alter this relationship between its resource availability and time to implementation, supporting faster PEWS implementation by enabling implementers to proactively identify and address PEWS barriers.
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