As the nation transitions to value-based care, health care practitioners continue to intensify their focus on incorporating those evidence-based practices that provide the maximum value and quality for their patients. In addition, patients and families, payers and regulatory organizations expect medical practice to be grounded not only in sound judgment but informed by the best evidence. In reality < 50% of medical practice is based on supportive scientific evidence, and when new evidence emerges it is estimated that it takes up to 15 years to incorporate into routine clinical practice. The Department of Pediatrics facilitates the use of evidence-based decision making through the implementation of guidelines, clinical pathways, and best care recommendations.

Guidelines, as defined in the 1990 Institute of Medicine report, are “systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” (Lohr, 1990). Guidelines provide condition/disease-specific care recommendations based on best scientific evidence. Guidelines are designed to eliminate the complexity of medical decision making, improve patient outcomes, promote quality care based on current knowledge and research, and reduce variation in practice that is either not scientifically defensible or clearly inappropriate. Guideline development involves the systematic review of evidence and an assessment of the benefits and harms of alternative care options.

Newborn Critical Care Center (NCCC) Guidelines

UNC DKA Guidelines

Goal-Directed Comfort Algorithm: Fentanyl and Dexmedetomidine > 40 kg

Goal-Directed Comfort Algorithm: Fentanyl and Midazolam > 40 kg

Goal-Directed Comfort Algorithm: Fentanyl and Dexmedetomidine < 40 kg

Goal-Directed Comfort Algorithm: Fentanyl and Midazolam < 40 kg

PICU Pathways and Guidelines (link).

Clinical Pathways provide a model for care delivery for a specific clinical problem. Pathways are designed to reduce practice variation and improve care quality and patient outcomes. These pathways are guideline-informed, task oriented, multidisciplinary and generally address the entire continuum of care. Key elements include detailed management steps and time or criteria based progression steps.

UNC ED Pediatric Asthma Pathway (PDF).

UNC ED Pediatric Sepsis Pathway (PDF).

UNC ED Pediatric Anaphylaxis Pathway (PDF).

UNC ED Pediatric Ovarian Torsion Pathway (PDF).

Inpatient Pediatric Asthma Pathway (PDF).

Empiric Acyclovir in Febrile/Hypothermic Infants Younger than 90 Days Pathway (PDF).

UNC Children’s Hospital Clinical Algorithm for Children with First Urinary Tract Infection (PDF).

Evaluation and Treatment of Children with Bronchiolitis in the ED (PDF).

Gastrostomy Pathway (PDF).

Pyloric Stenosis Pathway (PDF).

Nissen Gastrostomy Pathway (PDF).

Appendicitis Pathway (PDF).

Inpatient Anaphylaxis Pathway (PDF).

PICU Pathways and Guidelines (link).

Best Care Recommendations provide evidence- and/or consensus-based institutional recommendations for a focused clinical treatment or intervention.

BEST Recommendation – Standard IV Maintenance Solution (PDF).

RSI Drug List (PDF).

Pediatric Enteral Feeding Tubes (PDF).

Successful implementation of guidelines, pathways or best care recommendations can be challenging and requires deliberate planning, multiple strategies and careful execution. Plans for education and training, communication, monitoring and improvement to facilitate the uptake of recommendations should be defined. Tools to embed them into clinical practice include order sets, algorithms, and discharge instructions. Once implemented, guidelines, pathways and best care recommendations should be reviewed and revised annually and whenever new evidence emerges or significant change is needed.

Next: Department Quality and Safety Initiatives