title: Implementation strategies in pediatric neurocritical care.
abstract: OBJECTIVE
  Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes. We also provide an overview of the most effective strategies across the field of implementation science that can facilitate deployment of neurocritical care pathways in the pediatric ICU.
  
  
  RESULTS
  Implementation strategies can broadly be grouped according to six categories: planning, educating, restructuring, financing, managing quality, and attending to the policy context. Using a combination of these strategies in the last decade, several institutions have improved patient morbidity and mortality. Although much work remains to be done, emerging evidence supports that implementation of evidence-based care pathways for critically ill children with two common neurological diagnoses - status epilepticus and traumatic brain injury - improves outcomes.
  
  
  CONCLUSIONS
  Pediatric and neonatal neurocritical care programs that support evidence-based care can be effectively structured using appropriately sequenced implementation strategies to improve outcomes across a variety of patient populations and in a variety of healthcare settings.
authors.affiliation: aDivision of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis Children's Hospital bGeorge Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Markham
authors.forename: Enola K
authors.initials: EK
authors.lastname: Proctor
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000070642:Brain Injuries, Traumatic / Q000628:therapy*; D002648:Child; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D019091:Critical Pathways / Q000458:organization & administration*; D006801:Humans; D033183:Interdisciplinary Communication; D009462:Neurology; D010372:Pediatrics; D013226:Status Epilepticus / Q000628:therapy*