Emergency Department clinical algorithms: one academic medical centre's road to clinical excellence through collaborative practice

Abstract

Clinical pathways were first introduced into the US patient delivery system in 1988. Increased competition, high acuity, managed care and an emphasis on cost-effective quality care caused the University of California Irvine Medical Center (UCIMC) to consider the clinical path strategy of managing care. It should be noted that Executive Administrative support is necessary for the success of a programme addressing standardization of care up to, and including, the hospital Chief Executive Officer (CEO). Collaboration among departments is critical to successful pathway development and implementation. The clinical pathway programme began at UCIMC in 1999 and has resulted in the development and implementation of 21 inpatient pathways, which are measured for effectiveness quarterly. This programme has resulted in reduction in cost per discharge of 25%, with no identifiable negative quality impact. Clinical pathways had two major benefits: reduction in the practice variation and promotion of collaborative practice across medical, surgical and nursing disciplines. Due to the success of this programme, it was determined that a similar strategy would benefit the hospital’s EmergencyDepartment (ED),where, inour institution, 53% of admitted hospital patients begin their care. The ED already had a congruent goal to standardize physician and nursing practice, increase productivity and augment patient satisfaction. The Institute of Medicine, through its landmark report on errors in medicine, suggested that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way to reduce errors in emergency systems.