Successful implementation strategy to scale-up PEWS for children with cancer

Pediatric Early Warning Systems (PEWS)-;bedside tools used by nurses to assess the health of hospitalized children and identify urgent medical issues-; are not widely used in resource-limited hospitals, in part due to challenges with implementation. A recent article published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, reports on a successful collaboration to support implementation of a PEWS for children with cancer in Latin American hospitals.

In 2017, St. Jude Children’s Research Hospital partnered with pediatric oncology centers in Latin America to initiate Proyecto Escala de Valoración de Alerta Temprana (EVAT). St. Jude’s Asya Agulnik, MD, MPH, and her colleagues reported that from April 2017 to October 2021, 36 diverse hospitals from 13 countries in Latin America collectively managing more than 4,100 annual new pediatric cancer diagnoses successfully implemented PEWS through Proyecto EVAT.

Centers required an average of seven months to complete the implementation, and all of them-;despite challenges of geography, language, and the COVID-19 pandemic-;maintained high-quality PEWS use for up to 18 months after implementation. Across the 36 centers, more than 11,100 clinicians were trained in PEWS and more than 41,000 hospitalized children had PEWS used in their care.

This is the first multicenter, multinational study reporting a successful implementation strategy to regionally scale-up PEWS. The strategy used by Proyecto EVAT to regionally scale-up PEWS in these 36 resource-limited centers can be generalized to facilitate implementation of other interventions that improve patient outcomes in centers of all resource levels. We hope that lessons learned from this work can broadly inform future programs to promote adoption of interventions to improve cancer outcomes globally.”

Dr. Asya Agulnik, MD, MPH, St. Jude Children’s Research Hospital

Of note, a commentary published earlier this month in CANCER summarizes the top advances in pediatric cancer over the past 12 months. These pediatric cancer advances focus on solid tumor, brain tumor, leukemia, recurrent disease, and residual disease.


Journal references:

  • Agulnik, A., et al. (2022) Model for regional collaboration: Successful strategy to implement a pediatric early warning system in 36 pediatric oncology centers in Latin America. Cancer.
  • Pappo, A.S., et al. (2022) Top advances of the year: Pediatric oncology. Cancer.