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Description of a multihospital process to develop a care path for the child with acute lymphoblastic leukemia
L W McMahon1, P A Sealing, D H Mahoney
1National Association of Children's Hospitals and Related Institutions, Palm Harbor, FL 34685, USA.
Insights
This study outlines a collaborative care path for pediatric acute lymphoblastic leukemia (ALL) treatment across multiple hospitals. It emphasizes standardized care and early discharge planning for improved outcomes in childhood cancer.
Area of Science:
- Pediatric Oncology
- Healthcare Management
- Clinical Pathways
Background:
- Significant variation exists in the implementation of childhood cancer treatment protocols.
- Standardized care pathways are needed to improve consistency and outcomes for pediatric patients.
- The National Association of Children's Hospitals and Related Institutions (NACHRI) identified a need for a unified approach to acute lymphoblastic leukemia (ALL) care.
Purpose of the Study:
- To describe the development of a multihospital care path for children with acute lymphoblastic leukemia (ALL).
- To present strategies for the implementation and future direction of this standardized care pathway.
- To leverage a collaborative group process for creating a comprehensive and evidence-based care path.
Main Methods:
- Utilized a collaborative group process involving professionals from multiple institutions.
- Integrated evidence from literature, review of practice patterns, expert opinion, and consensus building.
- Organized the care path into six key categories, including assessment, diagnostics, teaching, and discharge planning.
Main Results:
- Developed a 4-day care path for pediatric acute lymphoblastic leukemia (ALL).
- Included specific discharge criteria at the outset to facilitate immediate planning.
- Incorporated clinical outcomes, parent/child skill development, and home assessment considerations.
Conclusions:
- A multihospital collaborative process enhances the development of comprehensive care paths.
- This approach leads to a care path that surpasses single-institution developed protocols.
- The developed care path provides a standardized framework for managing pediatric ALL, improving consistency in care delivery.
Abstract:
This article describes the National Association of Children's Hospitals and Related Institutions (NACHRI) collaborative group process used to create a multihospital care path for the child with acute lymphoblastic leukemia (ALL), and presents strategies for implementation and future direction. Although most children in the United States with cancer are treated according to National Cancer Institute-sponsored comprehensive protocols, there is a wide variation in the implementation of protocols by physicians and hospitals. The development of this care path was based on evidence from the literature, review of practice patterns, expert opinion, and group participant consensus building. The resulting 4-day care path was organized into six categories of care (e.g., assessment practices, diagnostic tests, teaching, and discharge planning). Discharge criteria are stated at the beginning of the care path to emphasize the planning process immediately on admission. Clinical outcomes, skill and knowledge outcomes for the parent and child, and home assessment considerations are also included. Strategies to create change and gain support of various stakeholders toward implementation of the care path are presented. The strength of the resulting care path is possible in large part because the multihospital group process brought professionals from around the country together to discuss, analyze, and reach consensus on the practices related to the child with ALL. The group process enabled the development of a care path that goes beyond a traditional care path developed by a single institution.