Learning Objectives: Incomplete knowledge and adherence to best practices in critical illness often leads to complications and poor outcomes. Creation of an international collaborative using a Quality Improvement approach (Checklist for Early Recognition and Treatment of Acute Illness and Injury in Pediatrics, CERTAINp) can facilitate timely and improved best practice delivery in countries with limited local resources and training in pediatric intensive care. Methods: A web-based platform was created using cognitive and ergonomic principles and integrated into the daily unit workflow to facilitate high quality, high value healthcare behaviors. 6172 pediatric critical care providers were contacted using World Federation of Pediatric and Intensive Care Societies listserv, with 78 PICUs across 34 countries responding (1.3%). 52% PICUs were classified as belonging to Low and Middle Income countries based on the World Bank Classification. 12/35 centers were recruited for this study. 5 centers are currently involved in baseline data collection phase with 2 centers entering the training phase. 183 decision support cards were designed and reviewed by pediatric critical care experts across the world. Innovative content management, team meetings and remote site co-ordination strategies were utilized using web platforms such as Google docs, Trello, MS Project, etc. Results: Data (demographic, lab, clinical, outcome measures, adherence to guidelines) has been collected on 75 patients from 3 centers with a mean patient age of 4.8 ± 4.9 yr; and ICU Length of Stay of 7 ± 6 days; 59% diagnoses were infection related, commonest being Pneumonia and Malaria; 28-day mortality was 28%. Logistic obstacles operating in 5 countries were time-zone differences, IT infrastructure, regional tropical diseases and varied usage of search engines. To overcome them, mobile and print versions of CERTAINp are being developed. Newer syndrome cards are frequently added. Conclusions: Requirement and opportunities exist for multi-center trials in developing countries. Adaptable research design and utilization of IT resources can overcome the barriers.
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