Successful Implementation of Workflow-Embedded Clinical Pathways During the COVID 19 Pandemic.

IF 1.2 4区 医学 Q4 HEALTH CARE SCIENCES & SERVICES
Quality Management in Health Care Pub Date : 2023-07-01 Epub Date: 2023-03-06 DOI:10.1097/QMH.0000000000000408
Sarah K Wendel, Kelly Bookman, Molly Holmes, Jennifer L Wiler
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引用次数: 2

Abstract

Background and objectives: Clinical pathways have been found effective for improving adherence to evidence-based guidelines, thus providing better patient outcomes. As coronavirus disease-2019 (COVID-19) clinical guidance changed rapidly and evolved, a large hospital system in Colorado established clinical pathways within the electronic health record to guide clinical practice and provide the most up-to-date information to frontline providers.

Methods: On March 12, 2020, a system-wide multidisciplinary committee of specialists in emergency medicine, hospital medicine, surgery, intensive care, infectious disease, pharmacy, care management, virtual health, informatics, and primary care was recruited to develop clinical guidelines for COVID-19 patient care based on the limited available evidence and consensus. These guidelines were organized into novel noninterruptive digitally embedded pathways in the electronic health record (Epic Systems, Verona, Wisconsin) and made available to nurses and providers at all sites of care. Pathway utilization data were analyzed from March 14 to December 31, 2020. Retrospective pathway utilization was stratified by each care setting and compared with Colorado hospitalization rates. This project was designated as a quality improvement initiative.

Results: Nine unique pathways were developed, including emergency medicine, ambulatory, inpatient, and surgical care guidelines. Pathway data were analyzed from March 14 to December 31, 2020, and showed that COVID-19 clinical pathways were used 21 099 times. Eighty-one percent of pathway utilization occurred in the emergency department setting, and 92.4% applied embedded testing recommendations. A total of 3474 distinct providers employed these pathways for patient care.

Conclusions: Noninterruptive digitally embedded clinical care pathways were broadly utilized during the early part of the COVID-19 pandemic in Colorado and influenced care across many care settings. This clinical guidance was most highly utilized in the emergency department setting. This shows an opportunity to leverage noninterruptive technology at the point of care to guide clinical decision-making and practice.

在2019冠状病毒病大流行期间成功实施工作流嵌入式临床路径。
背景和目的:临床途径已被发现可以有效地提高对循证指南的依从性,从而提供更好的患者结果。随着2019冠状病毒病(新冠肺炎)临床指南的快速变化和演变,科罗拉多州的一个大型医院系统在电子健康记录中建立了临床路径,以指导临床实践,并向一线提供者提供最新信息。方法:2020年3月12日,招募了一个由急诊医学、医院医学、外科、重症监护、传染病、药学、护理管理、虚拟健康、信息学和初级保健专家组成的全系统多学科委员会,根据有限的现有证据和共识,制定新冠肺炎患者护理的临床指南。这些指南被组织成电子健康记录中新的无中断数字嵌入路径(Epic Systems,Verona,Wisconsin),并提供给所有护理场所的护士和提供者。对2020年3月14日至12月31日的路径利用率数据进行分析。回顾性路径利用率按每个护理环境进行分层,并与科罗拉多州的住院率进行比较。该项目被指定为质量改进计划。结果:开发了九种独特的途径,包括急诊医学、门诊、住院和外科护理指南。对2020年3月14日至12月31日的路径数据进行分析,结果显示新冠肺炎临床路径使用了21099次。81%的通路利用发生在急诊科,92.4%的通路采用了嵌入式测试建议。共有3474家不同的医疗机构采用这些途径进行患者护理。结论:在科罗拉多州新冠肺炎大流行的早期,非中断性数字嵌入式临床护理路径被广泛使用,并影响了许多护理环境中的护理。该临床指南在急诊科应用最为广泛。这表明有机会在护理点利用无干扰技术来指导临床决策和实践。
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来源期刊
Quality Management in Health Care
Quality Management in Health Care HEALTH CARE SCIENCES & SERVICES-
CiteScore
1.90
自引率
8.30%
发文量
108
期刊介绍: Quality Management in Health Care (QMHC) is a peer-reviewed journal that provides a forum for our readers to explore the theoretical, technical, and strategic elements of health care quality management. The journal''s primary focus is on organizational structure and processes as these affect the quality of care and patient outcomes. In particular, it: -Builds knowledge about the application of statistical tools, control charts, benchmarking, and other devices used in the ongoing monitoring and evaluation of care and of patient outcomes; -Encourages research in and evaluation of the results of various organizational strategies designed to bring about quantifiable improvements in patient outcomes; -Fosters the application of quality management science to patient care processes and clinical decision-making; -Fosters cooperation and communication among health care providers, payers and regulators in their efforts to improve the quality of patient outcomes; -Explores links among the various clinical, technical, administrative, and managerial disciplines involved in patient care, as well as the role and responsibilities of organizational governance in ongoing quality management.
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