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Updated: Sep 21, 2026
Development and Implementation of a Multi-Disciplinary Technology Enhanced Care Pathway for Youth and Adults with Concussion
Published on: January 20, 2019
Development and implementation of a standardized pathway in the Pediatric Intensive Care Unit for children with
Lauren Rakes1, Mary King1, Brian Johnston1
1Harborview Medical Center, USA.
Insights
Implementing a standard care pathway improved adherence to pediatric traumatic brain injury (TBI) guidelines in a pediatric intensive care unit (PICU). This quality improvement initiative enhanced patient care for severe TBI in children.
Area of Science:
- Pediatric critical care medicine
- Neurotrauma management
- Quality improvement science
Background:
- Severe traumatic brain injury (TBI) significantly impacts pediatric morbidity and mortality.
- Evidence-based guidelines for pediatric TBI management exist, but adherence varies.
- Previous studies link guideline adherence to improved survival rates in TBI patients.
Purpose of the Study:
- To enhance adherence to pediatric TBI management guidelines within a pediatric intensive care unit (PICU).
- To implement a standardized care pathway for severe TBI in children.
- To evaluate the impact of a quality improvement project on guideline adherence.
Main Methods:
- Development of the Pediatric Guideline Adherence and Outcomes (PEGASUS) care pathway using a multidisciplinary approach.
- Implementation of iterative Plan-Do-Check-Act (PDCA) cycles for pathway refinement.
- Monitoring adherence to fourteen PICU TBI clinical indicators before and after pathway implementation.
Main Results:
- Initial adherence to TBI clinical indicators was 64% at a level 1 pediatric trauma center.
- Following the implementation of the PEGASUS care pathway, adherence increased to 80%.
- The quality improvement project demonstrated a significant increase in clinical guideline adherence over 18 months.
Conclusions:
- A standardized care pathway can effectively improve adherence to evidence-based guidelines for pediatric TBI.
- Quality improvement initiatives are crucial for optimizing the management of severe TBI in children.
- Enhanced guideline adherence in the PICU setting is associated with better outcomes for pediatric TBI patients.
Abstract:
Severe traumatic brain injury (TBI) is a leading cause of morbidity and mortality in children. In 2003 and 2012, the Brain Trauma Foundation established and refined evidence-based guidelines for management of severe TBI in children. A recent multicenter study demonstrated an association between TBI guideline adherence and improved discharge survival. However, this study also showed large variation in adherence to pediatric TBI management at our level 1 pediatric trauma center, where overall adherence to fourteen pediatric intensive care unit (PICU) TBI clinical indicators was 64%. The aim of this quality improvement project was to increase TBI guideline adherence by implementing a standard care pathway for PICU management of children with severe TBI. A multi-disciplinary approach was utilized to develop the Pediatric Guideline Adherence and Outcomes (PEGASUS) care pathway, and iterative PDCA cycles were performed. Over an 18 month period following pathway implementation, overall PICU clinical guideline adherence rate increased to 80%.
