Structure, Process, and Culture Differences of Pediatric Trauma Centers Participating in an International Comparative Effectiveness Study of Children with Severe Traumatic Brain Injury

Gitte Y. Larsen, Michelle Schober, Anthony Fabio, Stephen R. Wisniewski, Mary Jo C. Grant, Nadeem Shafi, Tellen D. Bennett, Deborah Hirtz, Michael J. Bell

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Traumatic brain injury (TBI) is an important worldwide cause of death and disability for children. The Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial is an observational, cohort study to compare the effectiveness of six aspects of TBI care. Understanding the differences between clinical sites—including their structure, clinical processes, and culture differences—will be necessary to assess differences in outcome from the study and can inform the overall community regarding differences across academic centers. Methods: We developed a survey and queried ADAPT site principal investigators with a focus on six domains: (i) hospital, (ii) pediatric intensive care unit (PICU), (iii) medical staff characteristics, (iv) quality of care, (v) medication safety, and (vi) safety culture. Summary statistics were used to describe differences between centers. Results: ADAPT clinical sites that enrolled a subject within the first year (32 US-based, 11 international) were studied. A wide variation in site characteristics was observed in hospital and ICU characteristics, including an almost sevenfold range in ICU size (8–55 beds) and more than fivefold range of overall ICU admissions (537–2623). Nursing staffing (predominantly 1:1 or 1:2) and the presence of pharmacists within the ICU (79 %) were less variable, and most sites “strongly agreed” or “agreed” that Neurosurgery and Critical Care teams worked well together (81.4 %). However, a minority of sites (46 %) used an explicit protocol for treatment of children with severe TBI care. Conclusions: We found a variety of inter-center structure, process, and culture differences. These intrinsic differences between sites may begin to explain why interventional studies have failed to prove efficacy of experimental therapies. Understanding these differences may be an important factor in analyzing future ADAPT trial results and in determining best practices for pediatric severe TBI.

Original languageEnglish (US)
Pages (from-to)353-360
Number of pages8
JournalNeurocritical Care
Volume24
Issue number3
DOIs
StatePublished - Jun 1 2016

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Trauma Centers
Pediatrics
Hospital Bed Capacity
Safety Management
Pediatric Intensive Care Units
Investigational Therapies
Quality of Health Care
Medical Staff
Neurosurgery
Critical Care
Clinical Protocols
Practice Guidelines
Pharmacists
Observational Studies
Cause of Death
Nursing
Cohort Studies
Research Personnel
Outcome Assessment (Health Care)
Traumatic Brain Injury

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Structure, Process, and Culture Differences of Pediatric Trauma Centers Participating in an International Comparative Effectiveness Study of Children with Severe Traumatic Brain Injury. / Larsen, Gitte Y.; Schober, Michelle; Fabio, Anthony; Wisniewski, Stephen R.; Grant, Mary Jo C.; Shafi, Nadeem; Bennett, Tellen D.; Hirtz, Deborah; Bell, Michael J.

In: Neurocritical Care, Vol. 24, No. 3, 01.06.2016, p. 353-360.

Research output: Contribution to journalArticle

Larsen, Gitte Y. ; Schober, Michelle ; Fabio, Anthony ; Wisniewski, Stephen R. ; Grant, Mary Jo C. ; Shafi, Nadeem ; Bennett, Tellen D. ; Hirtz, Deborah ; Bell, Michael J. / Structure, Process, and Culture Differences of Pediatric Trauma Centers Participating in an International Comparative Effectiveness Study of Children with Severe Traumatic Brain Injury. In: Neurocritical Care. 2016 ; Vol. 24, No. 3. pp. 353-360.
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abstract = "Background: Traumatic brain injury (TBI) is an important worldwide cause of death and disability for children. The Approaches and Decisions for Acute Pediatric TBI (ADAPT) Trial is an observational, cohort study to compare the effectiveness of six aspects of TBI care. Understanding the differences between clinical sites—including their structure, clinical processes, and culture differences—will be necessary to assess differences in outcome from the study and can inform the overall community regarding differences across academic centers. Methods: We developed a survey and queried ADAPT site principal investigators with a focus on six domains: (i) hospital, (ii) pediatric intensive care unit (PICU), (iii) medical staff characteristics, (iv) quality of care, (v) medication safety, and (vi) safety culture. Summary statistics were used to describe differences between centers. Results: ADAPT clinical sites that enrolled a subject within the first year (32 US-based, 11 international) were studied. A wide variation in site characteristics was observed in hospital and ICU characteristics, including an almost sevenfold range in ICU size (8–55 beds) and more than fivefold range of overall ICU admissions (537–2623). Nursing staffing (predominantly 1:1 or 1:2) and the presence of pharmacists within the ICU (79 {\%}) were less variable, and most sites “strongly agreed” or “agreed” that Neurosurgery and Critical Care teams worked well together (81.4 {\%}). However, a minority of sites (46 {\%}) used an explicit protocol for treatment of children with severe TBI care. Conclusions: We found a variety of inter-center structure, process, and culture differences. These intrinsic differences between sites may begin to explain why interventional studies have failed to prove efficacy of experimental therapies. Understanding these differences may be an important factor in analyzing future ADAPT trial results and in determining best practices for pediatric severe TBI.",
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