Department of Emergency Medicine, University of Virginia, Charlottesville (Dr Wendel); Department of Emergency Medicine, University of Colorado, Aurora (Drs Bookman and Wiler); and Clinical Quality Department, University of Colorado Hospital, Aurora (Ms Holmes and Dr Wiler).
Qual Manag Health Care. 2023;32(3):205-210. doi: 10.1097/QMH.0000000000000408. Epub 2023 Mar 6.
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.
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.
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.
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.
临床路径已被证明可有效提高对循证指南的依从性，从而改善患者的预后。随着 2019 年冠状病毒病（COVID-19）临床指南的快速变化和发展，科罗拉多州的一家大型医院系统在电子病历中建立了临床路径，以指导临床实践并为一线医护人员提供最新信息。
2020 年 3 月 12 日，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、信息学和初级保健方面的专家组成的系统范围的多学科委员会被招募来制定基于有限的可用证据和共识的 COVID-19 患者护理临床指南。这些指南被组织成电子病历（威斯康星州 Verona 的 Epic Systems）中的新颖的非中断数字嵌入式路径，并提供给所有护理场所的护士和提供者。从 2020 年 3 月 14 日至 12 月 31 日分析了路径使用数据。根据每个护理环境对回顾性路径使用进行分层，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。
制定了 9 条独特的路径，包括急诊、门诊、住院和外科护理指南。从 2020 年 3 月 14 日至 12 月 31 日分析了路径数据，显示 COVID-19 临床路径共使用了 21099 次。81%的路径使用发生在急诊部门，92.4%应用了嵌入式测试建议。共有 3474 名不同的医护人员使用这些路径为患者提供护理。
在科罗拉多州 COVID-19 大流行的早期阶段，非中断的数字嵌入式临床护理路径得到了广泛应用，并影响了许多护理环境中的护理。这种临床指导在急诊部门的使用最为广泛。这表明有机会利用护理点的非中断技术来指导临床决策和实践。
