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Creating a Robust Community of Practice as a Foundation for the Successful Development of a Pediatric Neurocritical
Jennifer C Erklauer1, Satid Thammasitboon2, Lara S Shekerdemian3
1Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Insights
Developing a pediatric neurocritical care (PNCC) program using a Community of Practice (CoP) framework successfully met most standards for a Level I Neuro-ICU. This approach can guide other institutions in establishing similar critical care programs for children.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Organizational development
Background:
- Growing need for specialized pediatric neurocritical care (PNCC) programs.
- Focus on improving care for critically ill children with neurological conditions.
- Exploration of the Community of Practice (CoP) model for PNCC program development.
Purpose of the Study:
- To develop a unique pediatric neurocritical care program.
- Utilize the Community of Practice (CoP) framework for program design and implementation.
- Establish a standardized and effective PNCC program within an academic children's hospital.
Main Methods:
- Process improvement project employing the CoP framework (domain, community, practice).
- Established a PNCC domain with a clear vision and organizational structure.
- Formed a core community of pediatric intensivists and neurologists.
- Standardized practice through core competencies and guidelines.
Main Results:
- Program evaluation using the Four-Frame Model and Neurocritical Care Society (NCS) standards.
- Met 92% (232 of 252) of NCS standards for a Level I Neuro-ICU.
- Implemented structural changes (pediatric Neuro-ICU, leadership), human resource initiatives (education, certification), political tailoring, and symbolic visioning.
Conclusions:
- The CoP framework effectively supported the development of a PNCC program.
- Achieved a majority of NCS standards for a Level I Neuro-ICU.
- The developed framework is generalizable to other institutions seeking to establish PNCC programs.
Background:
There has been a growing impetus for developing pediatric neurocritical care (PNCC) programs to improve care delivery for children with critical neurological conditions. We sought to develop a unique PNCC program using the concept of Community of Practice (CoP).
Methods:
This is a process improvement project in an academic Children's Hospital. Using CoP framework (domain, community, practice), we created a domain of PNCC with a stated vision and formal organizational structure, a core community of intensivists and neurologists interested in PNCC, and a standardized practice approach by establishing core competencies for PNCC and implementing practice guidelines.
Results:
We evaluated the program through the Four-Frame Model of Organizational Theory and Behavior (structural, human resource, political, symbolic) and by the Neurocritical Care Society's (NCS's) standards for a Level I Neurocritical Care Unit (Neuro-ICU). Structural frame included opening a pediatric Neuro-ICU, identifying PNCC leaders across specialties, and developing a multidisciplinary care delivery model. Human resource frame included forming physician and nurse groups with a primary role in PNCC and ongoing education through workshops, lecture series, and certification. Politically, program implementation was tailored to each department gaining institution-wide support for program initiatives. Symbolically, the PNCC program highlighted the vision to advance knowledge and best practices. Our program met 232 of 252 (92%) proposed NCS standards.
Conclusions:
The CoP as the foundation for program development has enabled us to achieve the majority of standards proposed by NCS for a Level I Neuro-ICU. The generalizability of these frameworks may facilitate the development of a PNCC program for other institutions.
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