Pediatric wound care: Establishing a consensus group to develop clinical practice guidelines

Introduction. Wound care practices for neonatal and pediatric patients have created a lack of standardized evidence-based guidelines for treatments in clinical practices. Unfortunately, published clinical guidelines for the evaluation and management of wounds in pediatric populations is limited. Consensus groups are used to develop clinical guidelines which define key aspects of the quality of health care, particularly appropriate indications for interventions. The aim of this initiative was to conduct the first two steps of the guideline development process, and to report on the findings from the expert consensus group for pediatric wound care. Methods. The goal was to recruit a multidisciplinary team that consisted of board certified Pediatric Plastic and Pediatric General Surgeons, WOCN, and research specialists active in the International Society of Pediatric Wound Care (ISPEW). All recruited individuals were emailed and invited to participate. For this study, an adapted questionnaire was created to assess eligibility criteria, information sources, systematic review database search strategies, study selection criteria including keywords. Data was collected on the clinical consensus group’s experience with clinical guideline development, and other clinically significant domains for which the the evidence should be evaluated. Results. All six invited individuals agreed to participate. 100% of respondents provided the number of years in their current role within their respective institutions and their length of experience with pediatric wound care management. 17% of respondents had 7 to 10 years in their current role, while 66% had more than 10 years practice in pediatric wound care. Domains identified as important to consider included: Cost of Product/Treatment Duration of Treatment, Ease of Applying Product/Performing Treatment, Accessibility of Product, Storage of Product, Length of Time to Apply Product/Perform Treatment. Discussion. The agreed-upon domains from our study align with previously published consensus group studies. We identified several domains to inform a future systematic review. At this time, no systematic review has been published that has been guided by consensus group domains and search terms for pediatric wound care. Conclusion. Through the use of this consensus group and conducted surveys, we identified the primary domains necessary to complete a practice-informed systematic review, as well as other key domains that are important in clinical pediatric wound care management

More Accessible and Easier to Deal With : A Qualitative Inquiry of Leaders\u27 Perceptions of the Evolving Roles and Responsibilities of Advanced Practice Providers at Texas Medical Center

Background. With over 10 million patient encounters a year at Texas Medical Center (TMC), Advanced Practice Providers (APPs) are being incorporated into health care delivery models. Moving beyond the narrow “scope of practice” debates that frequently surface when talking about APPs, this inquiry instead seeks to broaden the discussion and take a more comprehensive view of how APPs are being incorporated into health care delivery models that span across several TMC institutions. Methods. This study uses a thematic analysis study design to analyze structured interviews collected from a small convenience sample of Advance Practice Provider Program Directors at Texas Medical Center. A semi-structured interview guide was pilot tested for clarity and relevance of the questions. Results. The iterative thematic analysis approach saw four main themes emerge: 1) APP value to the team efficiency, 2) APP benefit to billing, productivity, and improved quality metrics, 3) variation in APP orientation and utilization, and 4) projected future growth of APPs. In addition, 4 institutions provided quantitative data from 2011 and 2016 about the number of APPs. Conclusions. The quantitative data analysis only further demonstrates the organic growth and presumed value equation that tilts towards APPs being an important part of the evolving healthcare workforce both now and in the years to come. This numeric information is consistent with the analyses and projections found in the relevant workforce reports periodically conducted and issued by the Health Resources Services Administration (HRSA)