Implementation strategies in pediatric neurocritical care

Abstract

Purpose of Review Brain-directed critical care for children is a relatively new area of sub specialization in Pediatric Critical Care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes. We also provide an overview of the most effective strategies across the field of implementation science that can facilitate deployment of neurocritical care pathways in the Pediatric Intensive Care Unit. Recent Findings Implementation strategies can broadly be grouped according to six categories: planning, educating, restructuring, financing, managing quality, and attending to the policy context. Using a combination of these strategies in the last decade, several institutions have improved patient morbidity and mortality. While much work remains to be done, emerging evidence supports that implementation of evidence based care pathways for critically ill children with two common neurological diagnoses-status epilepticus and traumatic brain injury-improves outcomes. Summary Pediatric and neonatal neurocritical care programs that support evidence based care can be effectively structured using appropriately sequenced implementation strategies to improve outcomes across a variety of patient populations and in a variety of health care settings.

The Pediatric Guideline Adherence and Outcomes (PEGASUS) programme in severe traumatic brain injury: a single-centre hybrid implementation and effectiveness study

“…Implementation science frameworks and optimization of systems of care are considered essential to achieve guideline adherence but there are no prospective studies testing implementation strategies to improve outcomes in either adult or pediatric TBI. 10,11 We tested the implementation and effectiveness of a new hospital wide program in severe pediatric TBI. We hypothesized that high-fidelity implementation of the hospital-based PEGASUS program would achieve acute care KPI adherence, and that achieving KPI adherence would be associated with better discharge outcomes.…”

“The First Thousand Days” Define a Fetal/Neonatal Neurology Program

“…Neonatal critical care survivors disproportionately represent multiple pediatric ICU admissions ( 241 , 242 ). Strategies to develop pediatric neurocritical programs must consider high-risk neonatal survivors ( 243 ) beginning during the first 1,000 days. Medically fragile children are more likely to suffer more severe intercurrent illnesses ( 244 ) with advancing ages into childhood.…”

Implementation of neurocritical care in Thailand

“…To achieve effective implementation, we adapted the proposed strategies in pediatric neurocritical care: planning, educating, restructuring, financing, and managing quality ( 17 ). We focus on planning, educating, and managing quality and try to minimize changes in the hospital structure and financing system.…”

“…Quality management and research are essential for effective implementation strategies ( 17 ). We will adopt the performance measure set proposed by the Neurocritical care society, consisting of twenty-one evidence-based performance measures specific to patients with neurocritical illnesses ( 50 ).…”