Pathway-based CPOE vs. standard ED workflow (n:49)
Adherence to clinical guideline/pathway orders Expected order was placed
Overutilization of unnecessary orders Unnecessary order placed
Blinded pilot study that radomized EM physicians and NPs to a simulated Curbside pathway-based CPOE vs. a control CPOE of their current Epic workflow. This model used 5 different disease processes and looked for behavior change in the ordering practices of the provider. Interesting the study was repeated with 20 EM nurses (RNs) who showed even more robust results than the physicians/NPs suggesting that the use of pathway-based CPOE may allow for less trained medical providers to make evidence-based clinical decisions in this setting.
Improving Time to Antibiotics in Fever in Pediatric Oncology Patients
Heather Hickman, RN
Emergency Nurses Association National Conference. Poster: Oct 2017.
Standard model for treating febrile pediatric patients with oncologic processes lead to changes in provider engagement, labs ordered, medications delivered and provider-provider handoff.
Novel Web-Based Algorithm for the Diagnosis and Management of Pediatric Acute Pancreatitis.
Ke-You Zhang, MD, Dan Imler, MD, Zachary M. Sellers, MD, PhD
Stanford University School of Medicine, Pediatric Research Retreat. Poster: Apr 2017.
First treatment algorithm for pediatric acute pancreatitis published in an open access location. Utilized by ~1,000 unique providers from 7 countries in the first 8 months.
Evidence-Based Clinical Pathways Improve Emergency Care For Children.
Dan Imler, MD
Spectrum Innovation Research Symposium Poster: Jan 2016.
Time to albuterol – ↓ 41.8 min (38.0%)
Time to steroids – ↓ 32.2 min (35.6%)
Time to steroids – ↓22.4 min (37.7%)
% Receiving albuterol – ↓ 9.6%
% Receiving ondansetron – ↑ 47.7%
Length of ED stay – ↓ 75.6 min (17%)
% Receiving opioids – ↓ 6.7% (30.7%)
% Receiving triptans – ↑ 7.6% (58%)
Time to headache medication – ↓ 28 min (23.3%)
Time to antibiotics – ↓ 51.3 min(49.9%)
Time to antibiotics – ↓ 119.9 min (70.2%)
Provider (MD/NP) survey regarding the value of augmented CPOE (n:81)
In uncomplicated, common medical problems, clinical pathways lead to improved CLINICAL outcomes: 85% Agree (40% strongly agree + 45% agree)
In uncomplicated, common medical problems, clinical pathways lead to improved OPERATIONAL outcomes (length of stay, patient satisfaction, costs, etc.): 89% Agree (44% strongly agree + 45% agree)
Have you ever had a clinical pathway/order set catch a clinical order that you might have otherwise missed? 83.6% Yes
Where in your workflow do you think the logic from clinical pathways would help you the most in making optimal clinical decisions? 84% Directly integrated into the EHR
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