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The Value of Quality


“Code Blue.” The voice coming from the Hospital’s loud speaker alerts medical staff to an emergency. “Code Blue” means a patient’s lungs or heart stopped working. Ever since Children's Hospital Central California implemented a technique known as the Pediatric Early Warning System Score (PEWSS), the unwelcome announcement has echoed through the Hospital’s hallways far less frequently. In fact, Children's Hospital went as long as 58 days with no acute care codes in 2011.

Nurses on computerIn fall 2010 Children’s began rolling out PEWSS in phases. By January we incorporated the system into inpatient units hospital-wide. Today, many caregivers at Children’s Hospital use the new process to identify a patient’s failing status up to 24 hours prior to the child having a code. The ability to recognize declining vital signs as early as possible can provide more time for lifesaving interventions and help eliminate preventable codes. 

“Most pediatric codes are related to respiratory problems or shock,” said Mary-Ann Robson, a registered nurse and clinical education specialist at Children’s. “Both of these causes are potentially reversible if identified early enough.” Robson spearheaded the PEWSS effort at Children’s to save lives.

PEWSS is part of a larger effort to standardize communication among caregivers and enhance identification and treatment of patients with deteriorating health. Even with an increase of about 4,000 acute care patient days in 2011, Children’s decreased our rate of acute care codes from 0.64 per 1,000 patient days in 2010 to 0.24 per 1,000 patient days in 2011.

“According to CHCA (Child Health Corporation of America) data, we went from being in the lowest quartile to a hair’s breadth away from the top quartile – in one year,” said Robson. “This means better, safer care for our children.”

Doctors on computerAccording to medical literature, only 10 percent of acute care patients suffering a cardiopulmonary arrest remain alive and neurologically unharmed one year following their code. Just one year after implementing PEWSS, Children’s is already seeing dramatic improvements. In 2011 we reduced our average of 30 acute care codes a year to 12, and as a result the number of deaths dropped 68 percent. There were 14 fewer deaths related to an emergency response or unplanned transfer to intensive care – meaning 14 fewer families suffered the devastating loss of a child.

“We’re saving kids,” said Beverly Hayden-Pugh, Children’s vice president and chief nursing officer. “These are remarkable results.”

Our commitment to stay abreast of the latest lifesaving techniques is improving care for patients with a broad spectrum of serious and often life-threatening conditions, from infectious disease, cancer, heart and gastroenterological issues to those who underwent surgery and/or require a respirator. The success of implementing new processes like PEWSS keeps Children's Hospital Central California on the cutting-edge of pediatric healthcare.