Abstract for: Assessing Intensive Care Unit Context for Implementing Evidence-Based Guidelines for Pediatric Severe Traumatic Brain Injury

Severe traumatic brain injury (sTBI) is a leading cause of pediatric death and disability. Despite wide dissemination and evidence indicating that adhering to the best available evidence described in the Brain Trauma Foundation (BTF) Guidelines improves mortality and functional outcome in sTBI, implementation of these guidelines is limited, particularly in pediatric patients. To improve guideline implementation and thereby outcomes, we are conducting group model building (GMB) sessions to assess the intensive care unit (ICU) context as perceived by nurses, physicians in training, and attending physicians at four US hospital sites. Participants visualized barriers and feedback loops in the causal models and identified relations and mechanisms crucial to successful implementation from their own perspectives. Results from the first seven sessions are relatively consistent across each provider type, with causal loop diagrams of the ICU workflow increasing in complexity from attending physicians to bedside nurses. Our analysis yields valuable information that will be used to implement a technology-based intervention linking BTF Guidelines and patient data to aid timely evidence-based decision making for ICU patients with sTBI. This study demonstrates the usefulness of GMB for advancing effective implementation of a technology-based intervention that ultimately aims at improving care and outcomes in the ICU.