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Pediatric Nephrology Clinical Pathway Development Team

BC Children's Hospital

The nephrology team at BC Children’s Hospital provides care for the province’s youngest patients with kidney problems. The health issues they face are often very complex, involving many health professionals and, until recently, substantial practice variation.

In 2011, an interdisciplinary Pediatric Nephrology Clinical Pathway Development Team set out to standardize care by developing evidence-based and locally-generated clinical pathways. In contrast to clinical practice guidelines, which consolidate available evidence, pathways weigh evidence, determine best practice and recommend how to implement the evidence into clinical care – while considering local context. The use of pathways in pediatrics is uncommon, particularly in pediatric nephrology.

The Pediatric Nephrology Clinical Pathway Development Team

In addition to clinical expertise, the team relied on experience in engagement, change management, knowledge translation, epidemiology, patient advocacy, community networking and teaching. They engaged and sought input from the families of children affected by nephrotic syndrome, a common childhood kidney problem, including in the design of a handbook and worksheets for parents which support them to provide at-home monitoring.

The team figured that a pathway could impact many of the estimated 3,000 visits to the nephrology program annually. It could shorten waitlists, reduce medical visits, focus the need for support services such as allied health and decrease non-evidence-based pharmaceutical drug use.

And they were right. Standardized care has allowed the team to follow newly-diagnosed children and determine why long-term outcomes may vary across the province. The number of adverse events has dropped, and consistency and effectiveness of care has improved.

For example, the team determined that with a pathway in place the number of relapses in the first year has decreased by 25%, and the number of patients who go on to develop frequently-relapsing nephrotic syndrome has decreased by 50%. Community physicians can now independently manage uncomplicated nephrotic syndrome cases, and immunization tracking has revealed that care providers need better support providing these patients with vaccinations which are not included in the standard immunization schedule.

The team has created a template so that other pediatric sub-specialty services can develop their own pathways, and it is exploring how an expanded role of clinical pathways could improve outpatient ambulatory care at the hospital. Excitingly, numerous trainees have worked with the team over the past eight years, including post-doctoral fellows, pediatric nephrology fellows, pediatric trainees, medical students, and graduate students from universities across Canada and numerous countries.

Thanks to the Pediatric Nephrology Clinical Pathway Development Team, children are receiving evidence-based, standardized and person-centred care – and the project’s impact is sure to move well beyond BC Children’s Hospital.