Pathways include an order set in the electronic medical record, providing suggested orders, embedded decision support, and references. Charges were converted to costs using the hospital-specific cost-to-charge ratio, then inflation-adjusted to 2013 US dollars using the medical care component of the Consumer Price Index.8,9 The same hospital cost-to-charge ratio was used for both study time periods. At Seattle Childrens, a clinical standard work (CSW) pathway is a documented approach to the management and treatment of a particular population or clinical condition. This approach allows for detection of differences in both trends over time (ie, the slope) and intercepts. A teenage boy arrives at Seattle Children's Emergency Department (ED) with an increased heart rate. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner's professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where . Seattle Children's Clinical Pathways | Center for Stewardship in NortonSP, PusicMV, TahaF, HeathcoteS, CarletonBC. Seattle Childrens Emergency Department (ED), Seattle Childrens Zero Suicide Initiative WSHA Community Health Leadership Award Winner 2019. Explore our network of care for kids, from the tiniest to teens and young adults. During the prepathway period, hospital costs per admission were steadily rising at a rate of $126 per month (95% confidence interval [CI] $60 to $191; Fig 2A). Careers, Unable to load your collection due to an error. Patients with pathway eligible admissions were similar in both time periods (Table 2). In this interrupted time series analysis of general pediatric inpatients, we found that implementation of standardized, pathway-based care was associated with a halt in rising hospital costs, decreased LOS, and stable physical functioning improvement scores over time, without detriment to readmission rates. Seattle Childrens Care Network Integrated Behavioral Health Program is part of the national Johns Hopkins Pediatric Integrated Care Collaborative, which promotes integrated healthcare and mental and behavioral health services. Pathway implementation is denoted by the dashed center line. AmbroggioL, ThomsonJ, Murtagh KurowskiE, et al. The SCCN program team which includes individuals from clinical, operations and data analytics roles provides local clinics with implementation and data support, training, education, ongoing coaching, funding, and more to build a sustainable integrated behavioral health model for supporting their community. We truncated groups at 36 months pre- and postpathway implementation, creating a 36 months category given fewer observations at the tails. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Order-set use varies by condition, from 100% order-set activation for eligible patients over time (eg, neonatal jaundice), to lower levels of use, especially immediately after implementation (eg, croup, 38% use in the initial 3 months and 68% use in the most recent 3 months; Table 1). Seattle Childrens complies with applicable federal and other civil rights laws and does not discriminate, exclude people or treat them differently based on race, color, religion (creed), sex, gender identity or expression, sexual orientation, national origin (ancestry), age, disability, or any other status protected by applicable federal, state or local law. In contrast, we found a significantly increasing trend over time in the percent of study patients with an inpatient compared with observation stay (prepathway slope 0.7% per month [95% CI 1.1 to 0.3], postpathway slope +0.9% per month [95% CI 0.5 to 1.2]; pre- to postpathway slope difference +1.5% [95% CI 1.0 to 2.1], P < .001). In this era of health care reform, an intervention such as that studied here, which was associated with maintained or improved patient-reported outcomes while decreasing or containing health care costs and LOS, could be considered by other hospitals and provider networks looking to increase the value of care provided. If you or a loved one is having thoughts of suicide, please call theNational Suicide Prevention Lifeline(800-273-8255) or text theCrisis Text Line(text HOME to 741741) for immediate, confidential support 24 hours a day, 7 days a week. An official website of the United States government. Unplanned 30-day readmissions were assessed from hospital administrative data. Using segmented regression, we found that prepathway LOS was stable over time, with a mean of 3.3 days and no significant slope to the regression line (Fig 2B). Philadelphia, PA 19104, Clinical Pathway for Patient with Suspected Preseptal or Orbital Cellulitis. Ineligible families included those who had completed the survey within the past 2 months, had a child who was immunocompromised, or who was admitted for suspected child abuse. Implementation of clinical pathways has previously been associated with varying degrees of improvement in clinical complications, physician documentation, LOS, and/or hospital costs, depending on study.4,1820 These previous studies, however, evaluated a single pathway at a time, generating evidence for the impact of a particular pathway within a particular context.2,4,2032 The inclusion of patients who received care from a diverse range of pathways was another strength of this study because it allowed for evaluation of the standardized pathway development and implementation process itself, rather than the elements of a particular condition-specific pathway. Individual results for LOS and physical functioning improvement were more variable, with few significant time trends for either period or the difference between periods. Brief resolved unexplained episode (BRUE), Multisystem inflammatory syndrome in children (MIS-C). The current US health care climate of high and increasing expenditures with poor health outcomes relative to most other developed nations requires interventions that can address the triple aim of simultaneously improving individual experiences of care, improving the health of populations, and reducing per capita health care cost.36 To achieve these goals requires understanding the impact of health care interventions on patient recovery, from the perspective of patients and families.37 The inclusion of a patient-centered outcome, physical functioning improvement postdischarge, ensured that this study addressed not only costs of care but important health outcomes, thus allowing us to assess the value of pathway implementation. New Initiative Aims to Prevent Youth Suicide - On the Pulse Dizziness (algorithm) - updated May 2022 E Ear infection (see Otitis media) (algorithms) - updated various dates Eating disorders (algorithm) - updated February 2023 Elevated TSH (see Hypothyroid) (algorithm) - updated October 2019 Eczema Eczema care advice for patients (Schmitt Pediatric Guidelines LLC) (415) 353-4395 Although combining diverse pathways allowed evaluation of standardization in general, it limited our ability to measure the impact on disease-specific clinical outcomes or track process measures that would indicate whether standardization resulted in decreased variability in care. Development of each CSW pathway begins with a literature review. Being able to intervene sooner for our kids is just one step in the right direction.. When no significant slope exists during the time period, the intercept is equal to the mean value for the time period. Pathway implementation is denoted by the dashed center line. Since then, more than 5,000 patients presenting for non-psychiatric complaints in the ED and inpatient settings have been screened. Seattle childrens Pediatric Clinical Pathways | Free Medical Apps for These crucial catches were made with help from a new clinical pathway known as Seattle ChildrensZero Suicide Initiative (ZSI), a universal screening method to help identify and treat youth at risk of suicide. Updated Clinical Standard Work Pathway for Febrile Seizure Murtagh KurowskiE, ShahSS, ThomsonJ, et al.. Asthma, Inpatient Asthma, PICU Child 6 months with Asthma and Respiratory Complaint COVID-19 Modifications Nursing - Focused History Questions Contact provider with concerning chief complaint Nursing - Obtain VS: HR, RR, Temperature, Pulse Oximetry Provider - Visual/Respiratory Assessment Determine Level of Severity of Asthma Exacerbation Pathway implementation was associated with a statistically significant halt in the rate of rise in costs (postpathway slope 29 per month [95% CI $100 to $34], P value for slope difference between time periods = .001; R2 = 0.98). Interrupted time series analysis results for costs of hospitalization and LOS, before and after implementation of pathways. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioners professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located. The https:// ensures that you are connecting to the Yes Obtain Additional Labs ECHO EKG ECHO (early if signs of cardiac CXR (if resp sx)dysfunction) Consider SepsisSepsis PathwayPathway Caution with boluses; monitor for cardiac dysfunction Lab Evidence of MIS-C? WolffM, SchinasiDA, LavelleJ, BoorsteinN, ZorcJJ. All estimates are followed by 95% CIs in parentheses. MitchellEA, DidsburyPB, KruithofN, et al.. A randomized controlled trial of an asthma clinical pathway for children in general practice. After pathway implementation, there was a significant increasing trend over time, at a rate of 0.5 points per month (95% CI 0.1 to 0.8), or 6 points per year, which exceeds the minimal clinically important difference of 4.5. Blood pressure tables, pediatric (tables 3 to 5), Chronic recurrent multifocal osteomyelitis (CRMO), Diabetes: Patients newly diagnosed with diabetes, Eye care: Community pediatric eye providers in Washington, Gender affirming medical care for youth (ages 11 to 17), Gynecology or Reproductive and Sexual Health referrals, Multisystem inflammatory syndrome in children (MIS-C), Acute otitis media with treatment failure, Postural orthostatic tachycardia syndrome (POTS), Algorithms and Other Clinical Care Resources for Referring Providers, New Referral Policies and PCP Resources (May 2020), Nondiscrimination and Interpreters Notice. Seattle Childrens developed the algorithms and other clinical care resources below with input from primary care providers to support your care of your patients. Before Skagit Pediatrics hired its first behavioral health specialist, its providers werent sure how many of their patients followed through on their referrals and received treatment because they were referring them to other behavioral health resources in the community. Treatment Resistant Depression and When is it Bipolar Disorder? Extraordinary kid care HulscherME, WensingM, van Der WeijdenT, GrolR. Interventions to implement prevention in primary care. After several years of research, planning and collaboration with multi-disciplinary stakeholders across Seattle Childrens, NIMH and other childrens hospitals across the United States using similar screenings, the ZSI team launched its pathway in March 2019. Clinical pathways can be a base upon which to improve the use of evidence-based therapies and help standardize care throughout Montana. Segmented linear regression was used to evaluate differences in intercept and trend over time before and after pathway implementation. NewmanRE, HedicanEB, HerigonJC, WilliamsDD, WilliamsAR, NewlandJG. For analyses, parent-proxy report was used for all patients aged <13 years. We were also unable to identify which particular steps within individual pathways had the greatest association with outcomes. From asthma exacerbations to febrile seizures, pediatric emergency medicine clinical pathways ensure we deliver high-quality care. Jaundice in 1st 24 hrs after birth. A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z, Ductal dependent systemic blood flow (pre-operative), Hem/Onc BMT suspected infection fever in community ED, IBD Acute severe ulcerative colitis medical management, Substance Use Screening and Management (SUSM). The pathway is intended to improve the safety and quality of care for children with a simple or complex febrile seizure. In 2010, Seattle Children's Hospital (SCH) undertook a hospital-wide initiative to develop and implement clinical standard work (CSW) pathways for a range of pediatric conditions. Accessibility Status Epilepticus | Connecticut Children's For questions, please contact Dr. Israel Green-Hopkins. One-year experience with an inpatient asthma clinical pathway. A designated owner/clinical champion and team lead the effort through development, implementation and improvement phases. The aim is to improve quality of care through the standardization of management based on evidence in published medical literature and/or expert opinion. The program focuses on building provider comfort across six key areas through training, education and ongoing coaching. In analyses exploring the relative contribution of each pathway, we found few statistically significant differences from the pre- to postpathway periods, likely because of smaller samples (Supplemental Table 3). For more information, please email us. If were not addressing all aspects of our patients health, including their mental health, then were not truly caring for kids to the best of our ability.. We used the Pediatric Medical Complexity Algorithm (PMCA)7 to classify children as having no chronic conditions, noncomplex chronic conditions, or complex chronic conditions, on the basis of retrospective ICD-9 codes, beginning with the date of admission and including up to a 3-year retrospective lookback period. To identify the pathway eligible cohort during the prepathway period, we used the same eligibility criteria that would have qualified for care on the pathway had the pathway been active. Pathway metrics are followed to confirm that goals are met or improvement in outcomes is occurring. All estimates are followed by 95% CIs in parentheses. Here to serve you DesaiAD, ZhouC, StanfordS, HaalandW, VarniJW, Mangione-SmithRM. During implementation, audit and feedback as well as targeted education by clinical champions are used to increase use. While some of the individual pathways were more impactful than others, the sample sizes within each pathway were generally too small to draw definitive conclusions about how much each pathway contributed to the overall findings. cDifference between pre- and postpathway period slopes is the calculated difference in time periodspecific slopes, indicating the change from the trajectory established during the prepathway period to the trajectory observed during the postpathway period. Provider-to-Provider Line (providers only) While theres no data to support this misleading theory, NIMH research showsthat the suicide rate for children ages 10 to 12 has substantially risen over the past 10 years. The nurse informs the provider, and an immediate plan is set in motion to further assess not only the patients physical health, but his mental health, as well. Risk Factors for Developing Significant Hyperbilirubinemia. Seattle Childrens Zero Suicide Initiative helps identify and treat children ages 10 and up who are at risk for suicide. 206-987-2000 A clinical pathway for pediatric gastroenteritis. We then considered all 15 pathways simultaneously, with the time of implementation lined up across pathways, and each pathway contributing a variable number of pre- and postimplementation months based on when it was rolled out within the study period. Seattle Childrens Care Network (SCCN) Integrated Behavioral Health Program helps kids receive behavioral health services from specialists embedded in their primary care clinic. 866-987-8899 (toll-free), Seattle Childrens Hospital Last month, Washington State Hospital Association (WSHA) representatives filmed Dr. Lori Rutman in an informational video about the Zero Suicide Initiative to share with hospital leaders across the state. There were 3808 and 2902 admissions in the pre- and postpathway groups, respectively. In 2010, Seattle Childrens Hospital (SCH) undertook a hospital-wide initiative to develop and implement clinical standard work (CSW) pathways for a range of pediatric conditions. His clinic, which serves about 10,000 active patients in Mount Vernon, a semi-rural town about 60 miles north of Seattle, was among the first of six primary care practices to participate. The monthly Provider News email provides updates for healthcare professionals about programs and services at Seattle Childrens. Disruptive Behavior and Aggression Care Guide, Crisis Prevention and Home Safety Recommendations (Alaska), Crisis Prevention and Home Safety Recommendations (Washington), Crisis Prevention and Home Safety Recommendations (Wyoming), Ayuda para el plan para la prevencin de crisis (Crisis Prevention and Home Safety Recommendations) (Alaska), Ayuda para el plan para la prevencin de crisis (Crisis Prevention and Home Safety Recommendations) (Washington), Ayuda para el plan para la prevencin de crisis (Crisis Prevention and Home Safety Recommendations) (Wyoming), Consejos para la terapia de relajacin (Relaxation Therapy), Fuentes de informacin para controlar ansiedad (Anxiety Resources), Fuentes de informacin sobre el autism (Autism Resources) (Alaska), Fuentes de informacin sobre el autism (Autism Resources) (Washington), Fuentes de informacin sobre el autism (Autism Resources) (Wyoming), Fuentes de informacin sobre el Trastorno por Dficit de Atencin e Hiperactividad (ADHD Resources), Fuentes de informacin sobre los trastornos alimenticios (Eating Disorders Resources), Fuentes de informacin sobre los trastornos de mala conducta y agresividad (Behavior and Aggression Resources), Orden en el sueo de los nios (Sleep Hygiene), Recursos para el abuso de sustancias (Substance Use Resources) (Alaska), Recursos para el abuso de sustancias (Substance Use Resources) (Washington), Recursos para el abuso de sustancias (Substance Use Resources) (Wyoming), Recursos para la depresin (Depression Resources) (Alaska), Recursos para la depresin (Depression Resources) (Washington), Recursos para la depresin (Depression Resources) (Wyoming), Abnormal Involuntary Movement Scale (AIMS), Pediatric Symptoms Checklist -17, General Mental Health Screen (PSC-17), Screen for Child Anxiety Related Disorders (SCARED), Short Mood and Feelings Questionnaire (SMFQ), Subscribe to the Washington PAL newsletter, See the Washington PAL newsletter archives, Depression Assessment and Treatment in Pediatric Primary Care, Psychiatric Management of Child and Adolescent Anxiety. Compared with prepathway care, postpathway care was associated with a significant halt in rising costs (prepathway vs postpathway slope difference $155 per month [95% confidence interval $246 to $64]; P = .001) and significantly decreased length of stay (prepathway vs post-pathway slope difference 0.03 days per month [95% confidence interval 0.05 to 0.02]; P = .02), without negatively affecting patient physical functioning improvement or readmissions. RotterT, KinsmanL, JamesE, MachottaA, SteyerbergEW. The CSW approach applied a standard process to develop and implement evidence-based clinical pathways, aiming to improve outcomes while reducing unnecessary . Follow UCSF Benioff Children's Hospitals: Follow UCSF Benioff Children's Hospital Oakland. Pediatric Clinical Pathways - Advocate Children's Hospital Use of this site is subject to theTerms of Use. Click below to download the clinical pathway PDFs. Inclusion in an NLM database does not imply endorsement of, or agreement with, Her parents have been taking her to therapy to help with her anxiety, and the therapist communicates his findings with them often. Their behavioral health team helps break down common barriers that prevent patients from accessing behavioral health care, including social stigma, limited access and challenges navigating the healthcare system. Clinical pathways, which standardize care for common conditions, are increasingly used as hospitals strive to provide higher value care by improving quality while containing costs.13 Pathway development aims to accelerate the implementation of evidence into clinical practice, thus decreasing unwarranted variability in care, which is known to lead to worse outcomes and higher costs.4,5, Current evidence supports the effectiveness of some individual pathways to decrease utilization and improve outcomes among specific patient populations.4 However, the impact of studied pathways varies by location and condition, making it difficult to know how much of the effect is due to pathway specifics and how much is due to standardization and reduced variability.2 Additionally, the evidence base for pathway use in pediatric populations is limited.3,6. Seattle Children's has updated the clinical standard work pathway for Urinary Tract Infection (UTI). By evaluating clinical pathways in aggregate, our findings support an association between evidence-based standardization and the outcomes studied.
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