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Use of clinical pathways integrated into the electronic health record to address the coronavirus disease 2019 (COVID-19) pandemic

Published online by Cambridge University Press:  22 March 2022

Allison H. Bartlett*
Affiliation:
Department of Pediatrics, University of Chicago, Chicago, Illinois
Sonya Makhni
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
Samantha Ruokis
Affiliation:
Quality Performance Improvement, University of Chicago Medicine, Chicago, Illinois
Mary Kate Selling
Affiliation:
Data and Analytics, University of Chicago Medicine, Chicago, Illinois
Lauren Hall
Affiliation:
Quality Performance Improvement, University of Chicago Medicine, Chicago, Illinois
Craig A. Umscheid
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
Cheng-Kai Kao
Affiliation:
Department of Medicine, University of Chicago, Chicago, Illinois
*
Author for correspondence: Allison H. Bartlett, E-mail: abartlett@peds.bsd.uchicago.edu

Abstract

Background:

The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and data reporting. To help address these challenges, our institution leveraged electronic health record (EHR)–integrated clinical pathways (E-ICPs), which are easily understood care algorithms accessible at the point of care.

Objective:

To describe our institution’s creation of E-ICPs to address the COVID-19 pandemic, and to assess the use and impact of these tools.

Setting:

Urban academic medical center with adult and pediatric hospitals, emergency departments, and ambulatory practices.

Methods:

Using the E-ICP processes and infrastructure established at our institution as a foundation, we developed a suite of COVID-19–specific E-ICPs along with a process for frequent reassessment and updating. We examined the development and use of our COVID-19–specific pathways for a 6-month period (March 1–September 1, 2020), and we have described their impact using case studies.

Results:

In total, 45 COVID-19–specific pathways were developed, pertaining to triage, diagnosis, and management of COVID-19 in diverse patient settings. Orders available in E-ICPs included those for isolation precautions, testing, treatments, admissions, and transfers. Pathways were accessed 86,400 times, with 99,081 individual orders were placed. Case studies demonstrate the impact of COVID-19 E-ICPs on stewardship of resources, testing optimization, and data reporting.

Conclusions:

E-ICPs provide a flexible and unified mechanism to meet the evolving demands of the COVID-19 pandemic, and they continue to be a critical tool leveraged by clinicians and hospital administrators alike for the management of COVID-19. Lessons learned may be generalizable to other urgent and nonurgent clinical conditions.

Type
Original Article
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Flores, EJ, Mull, NK, Lavenberg, JG, et al. Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme. BMJ Qual Saf 2019;28:476485.CrossRefGoogle ScholarPubMed
Lawal, AK, Rotter, T, Kinsman, L, et al. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review. BMC Med 2016;14:35.CrossRefGoogle ScholarPubMed
Kinsman, L, Rotter, T, James, E, et al. What is a clinical pathway? Development of a definition to inform the debate. BMC Med 2010;8:3.CrossRefGoogle ScholarPubMed
Institute of Medicine (US) Roundtable on Evidence-Based Medicine. The Learning Healthcare System: Workshop Summary. Olsen L, Aisner D, McGinnis JM, eds. Washington, DC: National Academies Press; 2007.Google Scholar
Guise, JM, Savitz, LA, Friedman, CP. Mind the gap: putting evidence into practice in the era of learning health systems. J Gen Intern Med 2018;33:22372239.CrossRefGoogle ScholarPubMed
Jabbour, M, Newton, AS, Johnson, D, et al. Defining barriers and enablers for clinical pathway implementation in complex clinical settings. Implement Sci 2018;13:139.CrossRefGoogle ScholarPubMed
Osheroff, JA, Teich, JM, Levick, D, et al. Improving Outcomes with Clinical Decision Support, An Implementer’s Guide, Second Edition. Chicago: Healthcare Information and Management Systems Society; 2012.CrossRefGoogle Scholar
Rotter, T, Kinsman, L, James, E, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database Syst Rev 2010;3:CD006632.Google Scholar
Flores, EJ, Jue, JJ, Giradi, G, et al. AHRQ EPC series on improving translation of evidence: use of a clinical pathway for C. difficile treatment to facilitate the translation of research findings into practice. Jt Comm J Qual Patient Saf 2019;45:822828.Google Scholar
Du, Z, Sun, X. Clinical pathway for the community-level management of patients with type 2 diabetes. Int J Health Plann Manage 2019;34:975985.CrossRefGoogle ScholarPubMed
Polak, SB, Van Gool, IC, Cohen, D, et al. A systematic review of pathological findings in COVID-19: a pathophysiological timeline and possible mechanisms of disease progression. Mod Pathol 2020;33:21282138.CrossRefGoogle Scholar
Reeves, JJ, Hollandsworth, HM, Torriani, FJ, et al. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc 2020;27:853859.CrossRefGoogle Scholar
Clinical Pathways Program. University of Chicago Medicine Center for Healthcare Delivery Science and Innovation. https://hdsi.uchicago.edu/clinical-pathways-program/. Accessed October 25, 2021.Google Scholar
Halpern, SD, Ubel, PA, Asch, DA. Harnessing the power of default options to improve health care. N Engl J Med 2007;357:13401344.CrossRefGoogle ScholarPubMed
Patel, MS, Volpp, KG, Asch, DA. Nudge units to improve the delivery of health care. N Engl J Med 2018;378:214216.CrossRefGoogle ScholarPubMed
Campbell, EM, Sittig, DF, Ash, JS, et al. Types of unintended consequences related to computerized provider order entry. J Am Med Inform Assoc 2006;13:547556.CrossRefGoogle ScholarPubMed

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