In search of the holy PEWS.

Pediatric hospitalists continue to search for ways to provide the safest and highest quality of care for our patients. We all want to recognize the deteriorating patient and bring additional resources to the patient or the patient to the resources. Pediatric Early Warning Systems (PEWS) have been developed, and some even validated, as tools to quickly identify the deteriorating hospitalized pediatric patient.1–6 In addition, we have borrowed the concept of rapid response systems from our colleagues “Down Under.”7,8 When rapid response systems have been evaluated, mixed effects on important patient outcome measures, including mortality and transfer to a higher level of care, have been identifi ed.7,9–14 In the current issue of Hospital Pediatrics, Panesar et al15 report the outcomes and adverse effects of mandatory coupling of an elevated PEWS score with activation of the rapid response team (RRT). Interestingly, the rate of RRT activation increased by 26%; however, we are not provided the data indicating if the increase was solely a result of mandatory triggering or based on patient characteristics. In addition, fewer patients were transferred to the PICU, which could be a result of better recognition and transfer before RRT activation or could be the result of mandatory triggering in patients who do not require a higher level of care. Overactivation is suggested by a decrease in the number of interventions before and after mandatory triggering. Despite the limitations noted, as well as those not noted, the authors should be commended for evaluating a mandatory process that uses critically precious hospital resources.