Child Health BC, in partnership with health authorities, are implementing and evaluating a pediatric early warning system in 14 hospital inpatient units that provide care to children across BC. In VCH, this will include Lions Gate, Richmond and Bella Coola Hospitals. Richmond Hospital will also be undertaking a pilot of PEWS in the emergency department. The experience and outcomes of these first BC sites will be used to inform implementation for the rest of the province.

Deterioration in pediatric patients can have serious adverse consequences including morbidity and death. Evidence indicates prevention is possible with early detection, mitigation, and escalation. Internationally, Pediatric Early Warning Systems (PEWS) have been implemented to improve safety for hospitalized children; these are particularly common throughout the USA, United Kingdom, Australia and Canada. In BC, health authority leaders and clinicians report that the PEWS is a high priority, and that critical incidents in their sites have escalated this priority.

The Provincial Pediatric Early Warning System includes:

• a risk score based on physiological findings incorporated into pediatric flow sheet,
• an escalation protocol,
• a situational awareness bundle (evidence-based risk factors), and
• a communication framework

Together these system parts are designed to provide a standardized framework and language to identify potential deterioration in a child; mitigate that risk; and escalate care as needed – all as early as possible. This is a unique initiative and the first of its kind in North America where an entire state or province adapts a standardized early warning system for pediatrics.