Implementation of a PEWS-integrated electronic SBAR handover model for pediatric inpatients: A nonconcurrent controlled study

This study aimed to evaluate observed changes in pediatric inpatient handover quality, efficiency, satisfaction, and safety-related indicators after implementation of a pediatric early warning score-integrated electronic Situation-Background-Assessment-Recommendation (SBAR) handover model. This single-center nonconcurrent controlled study was conducted in 3 general pediatric wards of a tertiary hospital in Jingzhou, China. The control period was January to March 2024 with routine SBAR handover, and the intervention period was June to August 2024 after development, electronic integration, and staff training. The same 47 pediatric nurses participated in both periods. The control period included 206 children and 384 handover observations; the intervention period included 212 children and 395 observations. Outcomes included bedside handover quality, nurse handover evaluation, family bedside handover perception, handover errors, handover efficiency, unplanned pediatric intensive care unit (PICU) transfer, and nursing adverse events. Because of the nonconcurrent design, findings were interpreted as observed between-period differences rather than direct causal effects. During the intervention period, bedside handover quality, nurse handover evaluation, and family bedside handover perception scores were higher than during the control period (93.66 ± 9.52 vs 83.93 ± 8.86; 58.21 ± 7.24 vs 52.51 ± 5.21; 63.23 ± 3.51 vs 55.59 ± 3.71; all P  < .001). The handover error rate was lower (6.84% vs 17.97%, P  < .01). Report-writing time and bedside handover time were shorter (2.11 ± 0.41 vs 4.51 ± 0.32 minutes and 3.94 ± 0.63 vs 5.97 ± 0.31 minutes; both P  < .001). The unplanned PICU transfer rate was numerically lower (0.94% vs 3.88%), but this finding was borderline and not statistically significant by Fisher’s exact test ( P  = .059). Nursing adverse events were less frequent during the intervention period (4.72% vs 11.17%, P  = .015). Implementation of a pediatric early warning score-integrated electronic SBAR handover model was associated with better handover quality, higher nurse and family evaluations, improved efficiency, fewer handover errors, and fewer observed nursing adverse events. The lower unplanned PICU transfer rate should be interpreted cautiously. Multicenter prospective studies are needed to confirm these findings.