Skip to main content


This site will be retired on JULY 1st, 2022. Please use the Children’s Clinical Care Portal for updated resources.

This toolkit is presented as a result of Project TICKER, which aimed to implement a patient- and family‐centered safe practice infrastructure for pediatric congenital heart surgery patients by incorporating teamwork training and integrated clinical pathways (ICPs) into the existing program at N. C. Children’s Hospital. During the first phase of the project, health care providers throughout the pediatric congenital heart surgery service line were trained in TeamSTEPPS®. During the next phase, expert panels from each clinical area designed, tested, and implemented ICPs for two congenital heart conditions: ventricular septal defect (VSD) and tetralogy of Fallot (TOF).

The toolkit is specifically designed for use in pediatric congenital heart surgery programs. However, much of the information and processes we describe could also be relevant (with adaptations) to other pediatric or adult surgical or medical service lines with or without national databases such as adult congenital heart, adult cardiovascular surgery, solid organ transplant, trauma, inflammatory bowel disease, cystic fibrosis, or sickle cell disease programs. In particular, much of the Getting Started section applies to patient- and family‐centered safe practice infrastructures in general. Teamwork training and coaching, as described in the Teamwork section, are applicable for all clinical areas. Finally, the process we present for developing ICPs can be used in various settings, even though the conditions and content of the pathways would be different. [Read full Overview]

Access the entire toolkit by section on this Web site:

Getting Started


Integrated Clinical Pathways


Lessons Learned


Download the Adobe Portfolio here.


Tina Schade Willis, MD, Principal Investigator
Erin J. Burgess, PMP
Ashley Purdy, MHA
Sara Massie, MPH
Karla Brown, RN, MSN, PNP
Celeste Mayer, PhD, RN
Brian Loveland, MPH


Scott H. Buck, MD
Michael R. Mill, MD




This project was funded under grant number R18 HS019638 from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. The opinions expressed in this document are those of the authors and do not reflect the official position of AHRQ or the U.S. Department of Health and Human Services.