Multi-Institution Harmonization of Infection Care Pathways for Pediatric Oncology

Care pathways are an implementation tool to help bridge the gap between evidence-based clinical practice guidelines and clinical practice. At four pediatric cancer institutions in Ontario, Canada, institution-specific care pathways for the management of infection complications in pediatric oncology were created. To standardize care delivery approaches across institutions, a project to harmonize the institution-specific care pathways was undertaken.

The institution-specific infection care pathways were compared. Discrepancies between the pathways were identified, and 33 care pathway components covering 10 clinical actions were prioritized for harmonization. An in-person harmonization meeting with representatives from all institutions was convened, where potential areas for harmonization were identified. At the end of the discussion of each clinical action, the institutional representatives gauged the feasibility of harmonization on a five-point Likert scale. A second virtual meeting was then held to finalize the harmonization plan.

Of the 33 care pathway components, harmonization was achieved for 25. Of the 10 components related to antibacterial and antifungal prophylaxis choice, timing, and indications, eight were harmonized. Harmonization was reached for 11 of 16 components related to the initial and ongoing management of febrile neutropenia. Harmonization was achieved for six of the seven components related to prolonged fever.

Harmonization of infection care pathways across institutions was achieved. However, certain care pathway elements may not be amenable to harmonization due to differences in institutional resources, cultures, and priorities.