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Development, implementation, and evaluation of a novel guideline engine for pediatric patients with severe traumatic
Meagan R Pilar1, Enola K Proctor1, Jose A Pineda2
1Washington University in St. Louis, Brown School, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130 USA.
Insights
This study introduces a new technology-based bedside guideline engine to improve care for children with severe traumatic brain injury (TBI). Feasibility testing will prepare for future trials assessing clinical outcomes and strategy adoption.
Area of Science:
- Pediatric critical care medicine
- Health informatics
- Implementation science
Background:
- Severe traumatic brain injury (TBI) is a major cause of death and disability in children.
- Evidence-based guidelines exist for pediatric severe TBI care, but implementation is inconsistent.
- Novel technology-based strategies are needed to improve guideline adherence in complex intensive care unit (ICU) settings.
Purpose of the Study:
- To develop and feasibility test a novel technology-based bedside guideline engine for implementing evidence-based guidelines in pediatric severe TBI care.
- To assess the potential of technology to support guideline adherence in the ICU.
- To prepare for a future clinical trial evaluating the engine's impact.
Main Methods:
- Mixed-method study employing group model building and systems dynamics to design the guideline engine.
- Initial assessment of bedside functionality through patient simulation.
- Feasibility testing in the ICU using the PARIHS framework, including quantitative (acceptance, readiness) and qualitative (interviews) data from providers and pediatric TBI patients at three trauma centers.
Main Results:
- Development of a novel technology-based bedside guideline engine.
- Initial assessment of the engine's functionality and feasibility in simulated and real-world ICU settings.
- Collection of quantitative and qualitative data on acceptance and readiness for change.
Conclusions:
- The study will yield an adaptable strategy for implementing guideline-based care for pediatric severe TBI.
- Feasibility testing of the bedside guideline engine is crucial for its future clinical application.
- A randomized clinical trial will further evaluate the engine's adaptability and impact.
Background:
Severe traumatic brain injury (TBI) is a leading cause of death and disability for children. The Brain Trauma Foundation released evidence-based guidelines, a series of recommendations regarding care for pediatric patients with severe TBI. Clinical evidence suggests that adoption of guideline-based care improves outcomes in patients with severe TBI. However, guideline implementation has not been systematic or consistent in clinical practice. There is also a lack of information about implementation strategies that are effective given the nature of severe TBI care and the complex environment in the intensive care unit (ICU). Novel technology-based strategies may be uniquely suited to the fast-paced, transdisciplinary care delivered in the ICU, but such strategies must be carefully developed and evaluated to prevent unintended consequences within the system of care. This challenge presents a unique opportunity for intervention to more appropriately implement guideline-based care for pediatric patients with severe TBI.
Methods:
This mixed-method study will develop a novel technology-based bedside guideline engine (the implementation strategy) to facilitate uptake of evidence-based guidelines (the intervention) for management of severe TBI. Group model building and systems dynamics will inform the guideline engine design, and bedside functionality will be initially assessed through patient simulation. Using the Promoting Action on Research Implementation in Health Services (PARIHS) framework, we will determine the feasibility of incorporating the guideline engine in the ICU. Study participants will include pediatric patients with severe TBI and providers at three trauma centers. Quantitative data will include measures of guideline engine acceptance and organizational readiness for change. Qualitative data will include semi-structured interviews from clinicians. We will test the feasibility of incorporating the guideline engine in "real life practice" in preparation for a future clinical trial that will assess clinical and implementation outcomes, including feasibility, acceptability, and adoption of the guideline engine.
Discussion:
This study will lead to the development and feasibility testing of an adaptable strategy for implementing guideline-based care for severe TBI, a strategy that meets the needs of individual critical care environments and patients. A future study will test the adaptability and impact of the bedside guideline engine in a randomized clinical trial.
