Clinical Pathways

YNHHS implemented a pulmonary embolism (PE) pathway to standardize diagnostic and therapeutic interventions. The pathway included risk stratification, criteria for PE Response Team (PERT) activation, indications for thrombolysis and catheter-directed therapy, and guidance for transition to enteral therapy.

• Patients in whom the pathway was utilized were more likely to receive catheter-directed therapy (CDT) (OR, 5.1; 95% CI, 3.1-8.3, p< 0.0001).
• Pathway patients had a 1.5-day reduction in hospital length of stay (HLOS) (95% CI -2.7 to -0.2, p=0.02).
• The reduction in HLOS for pathway patients translates to an annual cost avoidance of $189,000.

Through the implementation of an enteral access clinical pathway (EACP), YNHHS hoped to increase nutrition consults and decrease Emergency Department (ED) visits, readmissions, and overall length of stay.

• Those in the performance group were more likely to receive a nutrition consult (52.4% vs 48.0%, P < .01)
• They were less likely to re-present to the ED (31.9% vs 42.6%, P < .001),
• They were less likely to be readmitted to the hospital (31.0% vs 41.6%, P < .001.

The inpatient care team at UCM developed an opioid use disorder (OUD) workgroup, consult service, and pathway to guide clinicians on appropriate prescribing of buprenorphine-naloxone or methadone and monitoring parameters.

• Under the new program, 296 OUD consults occurred from July 2020 to April 2021.
• 35% received and were discharged with buprenorphine.
• 40% were managed with methadone and linked to outpatient care.
• Naloxone dispensing at discharge increased to over 65%.
• Patients with OUD who did not receive a consult had higher readmission rates (14.9% vs. 18.1%).

UCHealth developed a goals of care pathway that leveraged ED social workers and palliative care.

• More patients were identified as appropriate for hospice, social work consultations for hospice evaluation increased, and more patients were discharged from the ED with hospice.
• ED length of stay (LOS) for qualifying patients decreased by a median of 2.9 hours.
• Admission LOS decreased by a median of 18.4 hours.

Children’s Colorado implemented a clinical pathway to update guidance on treatment for community acquired pneumonia (CAP) and evaluated its effectiveness on antibiotic prescribing (prioritizing amoxicillin) and clinical outcomes.

• Prescribing of amoxicillin increased from 67% to 78%. The largest decrease occurred in azithromycin prescribing from 24% to 3%.
• Duration of therapy in the post-CCP group was statistically shorter compared to the pre-CCP group (7.5 days vs 5.9 days).

UCHealth compared the effectiveness of their EHR-embedded clinical pathway to a paper-based one on outcomes for patients presenting to the ED with suspected acute coronary syndrome (ACS).

• The frequency of hospital admission (unadjusted 28.2% to 20.9%, P < 0.001) and stress testing (unadjusted 15.8% to 12.7%, P < 0.001) significantly declined after the electronic pathway (ePATH) implementation.
• The pathway was associated with a significant reduction in hospital admissions (-10.79%, P < 0.001) and stress testing (-6.05%, P < 0.001).