# Pediatric Early Warning Score in interhospital ambulance care: a pilot study exploring feasibility and impact

## TL;DR

This pilot study explores the feasibility and impact of using a Dutch Pediatric Early Warning Score in ambulance care for children during hospital transfers.

## Contribution

The study introduces and evaluates the adaptation of a national PEWS for use in interhospital ambulance care in the Netherlands.

## Key findings

- Using DA-PEWS improved situational awareness and communication during interhospital transfers.
- The system was considered feasible for ambulance care, but challenges like organizational differences and low transfer frequency were noted.
- The pilot revealed important lessons for scaling the DA-PEWS nationwide due to regional variations in ambulance care.

## Abstract

Pediatric Early Warning Scores (PEWS) are commonly used for early recognition of clinical deterioration in hospitalized children and timely intervention. In 2019, a national Dutch PEWS was developed for pediatric hospital care in the Netherlands. To improve communication during interhospital transfers, using Dutch PEWS in interhospital ambulance care might be of added value in the chain of care. Therefore, this pilot study aimed to explore the feasibility and impact of the Dutch PEWS in interhospital ambulance care.

Using the Plan-Do-Study-Act cycle, a four-step model for carrying out change, the Dutch PEWS system was first adopted for use in interhospital ambulance care, resulting in Dutch-Ambulance-PEWS (DA-PEWS) (Plan). This system was implemented in one ambulance region: the Regional Ambulance Service Utrecht (RAVU) (Do). Feasibility for implementing DA-PEWS nationwide and impact were evaluated. To do so, one baseline questionnaire and semi-structured interviews at the start of and at three, six, and twelve months after implementation were used (Study). Based on the results, approaches were developed to disseminate the DA-PEWS to national ambulance care (Act).

Main impact themes that emerged included the enhancement of situational awareness, communication in the chain of care through improvements in uniformity and handovers and improved protocol adherence. Using the system in the interhospital care setting was considered feasible, but for future upscaling of the implementation and efficacy, determinants such as variation in organizational structures, the limited frequency of pediatric interhospital transfers and differences in individual attitudes toward using one system are first steps to consider.

This pilot study showed impact of using the DA-PEWS in interhospital ambulance care in the Netherlands, while also revealing important lessons for the implementation of the DA-PEWS nationwide due to local contextual factors in the organization of ambulance care across regions.

The online version contains supplementary material available at 10.1186/s13049-025-01383-6.