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.

中文翻译：

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创建一个强大的实践社区作为成功开发儿科神经重症监护计划的基础

背景

开发儿科神经重症监护 (PNCC) 计划以改善对患有严重神经系统疾病的儿童的护理服务越来越受到推动。我们试图利用实践社区 (CoP) 的概念开发一个独特的 PNCC 计划。

方法

这是一个学术型儿童医院的流程改进项目。使用 CoP 框架（领域、社区、实践），我们创建了一个具有明确愿景和正式组织结构的PNCC领域，一个由对 PNCC 感兴趣的重症医师和神经科医生组成的核心社区，以及通过建立 PNCC 核心能力和实施的标准化实践方法实践指南。

结果

我们通过组织理论和行为的四框架模型（结构、人力资源、政治、象征）和神经重症监护协会 (NCS) 的一级神经重症监护病房 (Neuro-ICU) 标准评估了该计划。结构框架包括开设儿科神经重症监护室、确定跨专业的 PNCC 领导者以及开发多学科护理提供模式。人力资源框架包括组建在 PNCC 中发挥主要作用的医师和护士团体，并通过研讨会、讲座系列和认证进行持续教育。在政治上，项目实施是为每个部门量身定制的，获得了全机构对项目倡议的支持。象征性地，PNCC 计划强调了推进知识和最佳实践的愿景。我们的计划符合 252 项 (92%) 提议的 NCS 标准中的 232 项。

结论

CoP 作为项目开发的基础，使我们能够实现 NCS 为 I 级神经 ICU 提出的大多数标准。这些框架的普遍性可能有助于为其他机构制定 PNCC 计划。