Developing a Comprehensive Care Pathway for Vascular Access Delivery in Hospitalized Children - PROJECT SUMMARY/ABSTRAT Dr. Alina Burek is an Associate Professor of Pediatrics and a Pediatric Hospitalist at Medical College of Wisconsin and Children’s Wisconsin. Her career goal is to become an independent clinician-scientist working to improve vascular access care in hospitalized children by identifying and developing interventions that make vascular access care delivery effective, safe, patient-centered, and cost effective. Annually, over 4 million US hospitalized children require a vascular access catheter during their medical evaluation and treatment, making intravenous (IV) catheter placement the most common invasive procedure in hospitalized children. Without clear benchmarks for guidance, the delivery of vascular access care is variable and frequently ineffective. The ineffective delivery of vascular access–multiple venipuncture attempts, catheter failure, complications–causes treatment delays, added staff time, distress to ill children and their families, and cost to the healthcare system. Vascular access care delivery is a complex process, involving different components (assessment, selection, placement), a wide range of patients, an array of catheters (peripheral vs central), and a diverse group of clinicians with different training and experiences who place these catheters. Improving a complex process requires a multi-level intervention that addresses gaps at each point along the care process, a comprehensive care pathway. The main objective of this proposal is to develop and test a novel, user and patient-centered vascular access pathway (VAP) for the initial delivery of vascular access care in children hospitalized to the acute care units. Our specific aims are to: (1) Co-design the VAP for the initial delivery of vascular access care in hospitalized children. (2) Test the VAP in a single-site adaptive pragmatic clinical trial. To accomplish our first aim, we will use a mixed methods exploratory sequential design (qualitative → quantitative) to prospectively engage key stakeholders (clinicians, organizational leaders, patients/families) at US pediatric centers to (a) describe stakeholders’ experience with vascular access care, identify current barriers/facilitators to high-quality care, and define elements of effective vascular access care delivery (qualitative phase), and (b) prioritize the elements of a VAP (quantitative phase). Through an iterative experience-based co-design approach using live sessions/workshops with a multidisciplinary vascular access advisory panel, we will co- design the VAP incorporating essential elements for each point along the care process – assessment, selection, and placement. To accomplish aim 2, we will first assess the feasibility (process evaluation) and stakeholders’ acceptability of the novel VAP (phase 1) and then assess its effectiveness (first attempt success rate) as compared to usual care (phase 2). Patient-reported outcomes (pain, anxiety) will be explored in a subgroup of patients. Guided by the CFIR framework, we will explore barriers and facilitators to VAP implementation and sustainability.
