Creating a Robust Community of Practice as a Foundation for the Successful Development of a Pediatric Neurocritical Care Program

Jennifer C Erklauer; Satid Thammasitboon; Lara S Shekerdemian; James J Riviello; Yi-Chen Lai

doi:10.1016/j.pediatrneurol.2022.07.014

Creating a Robust Community of Practice as a Foundation for the Successful Development of a Pediatric Neurocritical Care Program

Pediatr Neurol. 2022 Nov:136:1-7. doi: 10.1016/j.pediatrneurol.2022.07.014. Epub 2022 Aug 7.

Authors

Jennifer C Erklauer¹, Satid Thammasitboon², Lara S Shekerdemian³, James J Riviello⁴, Yi-Chen Lai³

Affiliations

¹ Division 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. Electronic address: jclee@bcm.edu.
² Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas; Center for Research, Innovation and Scholarship in Medical Education, Texas Children's Hospital, Houston, Texas.
³ Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
⁴ Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.

PMID: 36029730
DOI: 10.1016/j.pediatrneurol.2022.07.014

Abstract

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.

Keywords: Intensive care units; Medical education; Neurology; Organization and administration; Pediatric; Pediatric neurocritical care unit.

MeSH terms

Child
Critical Care
Hospitals, Pediatric
Humans
Nervous System Diseases*
Neurology* / education
Workforce