A Global Pediatric Network

from science to practice

1st global congress for Consensus

in pediatrics and child health.

Paris. Feb, 16th, 2011

Fabrice Brunet, MD,PhD

CEO, Sainte Justine UHC

Chair, Board of the RMEF

Professor of pediatrics

University of Montreal

Agenda

• Implementing consensus at the bedside in

Pediatrics

• Global Pediatric Network and Knowledge

management

• Designing an international network to

translate knowledge

Why should we implement

consensus at the bedside?

• Evidence-based care help to improve

– Quality of care and patient safety

– Performance and efficiency

– Academic mission

– Translational research

• Mission of pediatrics University Health Centers

– Provide the best care and services to children and families

– Respond to the needs of the hospital and the region

– Contribute to knowledge generation and translation

– Improve maternal and children’ health

Randolph AG and Pronovost P Reorganizing the delivery of intensive care could improve

efficiency and save lives J Eval Clin Pract 2002; 8:1-8.

Barriers to knowledge

translation

• Physicians’ barriers to guideline implementation – No time, no financial incentive

– Guidelines are too theoretical and/or overcomplicated

– Perceived lack of applicability due to patient characteristics or clinical situation

• Teams’ barriers: – Shared decision-making has not been widely adopted

– Lack of teamwork and inter team collaboration

– Time constraints of health professional team (in working together)

• System barriers: - Model of care delivery doesn’t allow implementing evidence

- Lack of appropriate settings and technologies

- System organization doesn’t allow continuum of care

1- Graham. European Society of Cardiology 2006; 13:839-45; 2- Gravel. Implementation Science 2006; 1(16); 3- Chaillet. Obstetrics & Gynecology 2006; 108(5): 1234-45

Physicians’ barriers

• Evidence is based on integrating clinical expertise and best external scientific results.

• Evidence-Based Medicine is defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of people.”

• Personal experience should not be confused as “evidence” for the basis of guidelines and/or protocols, although local experience should help modify these tools.

However, scientific results are not always directly applicable to

our patients resulting in controversies and barriers

D. Sackett et al, “Evidence based medicine: what it is and what it isn't” BMJ 1996;312:71-72

Teams’ barriers

• Physicians

• Fellows, Residents

• Nurses

• Respiratory therapists

• Physiotherapists

• Pharmacists

• Dietitians

• Social workers

• Nephrology

• Gastro-enterology

• Infectious disease

• Cardiology

• Surgery

• Neurology

• Respirology

• Imaging

Multidisciplinary ICU team Consultant services

System barriers

Rachid Amini, Unité de recherche en traumatologie, Hôpital de l’Enfant-Jésus

• Severe traumas in children need a specific approach

especially in children < 5 yrs

• Prehospital and level 1 hospital response should include

protocols for chidren with severe traumas

• A retrospective study performed in the Quebec trauma

system reported higher mortality in non specialized

pediatric trauma centers

• Recommendations were to improve triage on scene and

direct transfer to the level 3 pediatric trauma centers

« Réseau mère enfant de la francophonie » :

A global pediatric network dedicated to maternal and

children health

AMERICA CHU Ste-Justine,

Montréal, Canada

CHU de Québec,

Québec, Canada

CHU de Sherbrooke

Sherbrooke, Canada

AFRICA CHU d’Antananarivo,

Madagascar

Centre mère et enfant de

Yaoundé, Cameroun

Le CHU IBN Sina, Rabat,

Maroc

Le CHU Mongi Slim La

Marsa, Tunis, Tunisie

EUROPA

CHRU de Lille, France

CHU de Nantes, France

L’Hôpital Robert Debré, Paris, France

L’Hôpital Armand-Trousseau, Paris, France

Les Hospices Civils de Lyon, France

L’Assistance Publique des Hôpitaux de

Marseille, France

Les Hôpitaux Universitaires de Genève, Suisse

Le Réseau IRIS des Hôpitaux de Bruxelles,

Belgique

Le CHR La Citadelle à Liège, Belgique

Le CH Emile Mayrisch, Luxembourg

Hôpital Necker enfants malades, Paris, France

Le CHU de Bordeaux, France

MEMBERS - RMEF

MIDDLE-EAST L’Hôtel Dieu de France,

Beyrouth, Liban

MISSION Support the development of best practices in care and in

management for the members of mother and child network in a French-speaking space

Our identical tracks are in the field of

Research : Evaluative research concerning medical practices

and organization of care

Teaching : Concepts and methods of knowledge transfer

Care : Design and share of communities of practices

Management : Management of processes and comparison of

organization and models of care delivery

LE RMEF…

RESEARCH (2009-2010)

Enquête franco québécoise sur les déterminants de la publication en

pharmacie hospitalière

Sélection d’un set d’indicateurs de qualité en gynécologie obstétrique

commun aux maternités du Réseau mère-enfant de la Francophonie

Validation multicentrique du score de déshydratation pédiatrique

Altération des propriétés biophysiques de la circulation artérielle

systémique suite à la maladie de Kawasaki.

PEDIPATCH Détection des problèmes reliés à la thérapeutique des patients

hospitalisés dans des services de pédiatrie francophone. Étude

multicentrique des interventions des pharmaciens dans les services de soins.

Prévalence de la métaplasie gastrique et/ou intestinale de l’œsophage et

des lésions d’oesophagite chez les patients opérés d’une atrésie de

l’œsophage. Étude pilote

Étude de la validation du score Paediatric Index of Mortality 2 (PIM2)

utilisant le rapport SpO2/FiO2 à la place du rapport PaO2/FiO2 . Étude

multicentrique francophone

Registre international des infections cutanées sévères admises en

réanimation pédiatrique

URGENCES ET SOINS INTENSIFS PÉDIATRIQUES :

une approche multidisciplinaire

Outil de référence en français

Traité spécifique et rigoureux

…qui se veut une approche comparative menant à un

consensus international de prise en charge de

l’enfant en situation d’urgence

un échange de savoir-faire entre experts de

différentes disciplines

Un partenariat impliquant plusieurs pays

Européens ( 85 auteurs)

27 institutions françaises (65 auteurs)

7 institutions belges (11 auteurs)

4 institutions suisses (8 membres)

1 participant d’une institution des Pays-Bas

18 institutions nord-américaines (66 auteurs)

CHU Sainte-Justine

CHUQ

KNOWLEDGE TRANSFER

Un colloque annuel auquel participent plus de 250 gestionnaires,

médecins, soignants et chercheurs

2003 : Bruxelles

De la mère à l’enfant, les défis pour l’avenir

2004 : CHR de Lille

Colloque médical international

2005 : HU Genève

Vers des soins de qualité: accessibilité, efficacité et satisfaction du patient

2006 : Hôpital Robert Debré, Paris

Recherche clinique, enseignement et formation

2007 : CHU Sainte-Justine, Montréal

Culture et continents: partager le savoir

2008 : Hospices civils de Lyon

La mère, l’enfant et leur environnement à l’hôpital

2009 : CHUQ - CHUS

Enseignement et qualité : un monde de perspectives

2010 : CHR la Citadelle Liège – IRIS Bruxelles

L’enfant différent : du diagnostic à la vie sociale

KNOWLEDGE TRANSFER

Un stage annuel pour les professionnels du RMEF regroupant des

médecins, des soignants et des gestionnaires dans le CHU hôte

du Colloque.

Stages d’observation clinique

Des activités thématiques

Partage d’expériences

Jumelage avec des intervenants

Visite d’hôpitaux

Tribune d’échange

2004 : CHR de Lille 8 participants

2005 : HU Genève 19 participants

2006 : Hôpital Robert Debré, Paris 18 participants

2007 : CHU Sainte-Justine, Montréal 53 participants

2008 : Hospices civils de Lyon 40 participants

2009 : CHUQ et CHUS 53 participants

2010 : IRIS Bruxelles et CHR la Citadelle Liège

KNOWLEDGE TRANSFER

2007 : Hôpital Robert Debré, Paris La gestion par pôles-clientèle

(CHU Sainte-Justine, Hôpital Robert Debré, IRIS, HUG )

2008 : Hôpital Robert Debré, Paris

Les indicateurs de performance dans la gestion des CH

(Liban, CHUS, Bordeaux, HRB Paris, HUG)

2009 : CHUS

La gestion des ressources humaines

2010 : CHR la Citadelle Liège

La périnatalité: l’expérience de 6 pays

MANAGEMENT

KNOWLEDGE MANAGEMENT

Research

committee

Consensus

Managers

committee

Clinicians

committee

Education

committee

Emergency

Critical care

Le CH Régional de la Citadelle à Liège, BELGIQUE

Le Réseau IRIS des Hôpital publics de Bruxelles, BELGIQUE

Le Centre mère-enfant, Yaoundé, CAMEROUN

Le CHU de Nantes, FRANCE

L’Assistance publique des Hôpitaux de Marseille, FRANCE

Les Hospices Civils de Lyon, FRANCE

Hôpital Robert Debré, Paris, FRANCE

L’Hôpital Necker – Enfants malades, Paris, FRANCE

Le CHRU de Lille, FRANCE

Le CHU de Bordeaux, FRANCE

L’Hôtel-Dieu de France, Beyrouth, LIBAN

Le CHU D’Antananarivo, MADAGASCAR

Le CHU Ibn Sina de Rabat, MAROC

Le CHU Sainte-Justine, Montréal, QUÉBEC

Le CHU de Québec, QUÉBEC

Le Centre Hospitalier universitaire de Sherbrooke, QUÉBEC

Les Hôpitaux universitaires de Genève, SUISSE

Le CHU Mongi Slim La Marsa, Tunis, TUNISIE

Asthma crisis, treatment

Severe Trauma

Acute Sickle-cell crisis

Blood transfusion

Severe sepsis

Venous thrombosis

Questionnaire of practice

From Consensus to Practice

An international network of

knowledge translation

Evaluation

SCIENCE PRACTICE

Knowledge Transfer

Managers

Clinicians Teachers

Patients Researchers

a multidisciplinary approach

créatrice

de savoir

AnimalModels

Human Specimens &

clinical data

Public Health

In vitro and ex vivo studies

Genome Sequencing

Metabolomics & high-throughput assays

Bench to bedside to business

Generating knowledge

An access to the networks

• of health promotion

• of cares

• of rehabilitation

in Québec

in Canada

In French-speaking

communities

• 20 organizations

• 10 countries

International

• 5 continents

A worldwide expertise

Sharing knowledge

Knowledge center

Virtual community

Implementing knowledge

• Knowledge translation requires to define

– Object: guideline, protocol, pathway

– Target: patients population, acuity and severity

– Effecter: Physician, team, multiple teams

– System: organized or not

• Overcoming barriers needs planning

– Prospective identification of efficient strategies & barriers to change

– Multifaceted interventions rather than single strategies

F. Brunet and R. Anas St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, Canada

Frontline teams are included in

the multidisciplinary project

management from the beginning

Project management

Simulation is used to

design projects along their

adaptation to the environment

Improves team performance and inter-team collaboration

Change management

• E.Forums as:

• Conflict resolution tool

between teams

• Input from frontline

caregivers

• Design of new

protocols

• Enhanced compliance

of caregivers

R. Bowry, Medical Director CVICU, St. Michael’s Hospital, Toronto

Organizing care environment

• Evidence-based design is “the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.”

• New environments integrate care, research and education at the bedside to facilitate knowledge management

Ulrich. Health Environment Research and Design; 1:61-125.

Developing environment to generate and transfer knowledge

Building care delivery units

Organizing the system

Nathens. JAMA 2000;283:1990-4; MacKenzie. N Engl J Med. 2006; 354:366-78.

Trauma

System

Summary

• Guidelines are challenging to be implemented in paediatrics

• PGN has developed a unique expertise in knowledge

management through international collaboration • Improving children’ care requires synergy between

researchers, educators clinicians and managers • PGN offers a specific and dedicated environment to

share knowledge and develop such a synergy