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The benefits of using clinical pathways for managing acute paediatric illness in an emergency department
G J Browne1, H Giles, M E McCaskill
1Department of Emergency Medicine, The Children's Hospital at Westmead, Royal Alexandra Hospital for Children, NSW, Australia. garyb@chw.edu.au
Insights
Clinical pathways significantly improved pediatric emergency care, reducing hospital admissions by threefold and length of stay by half. Patient re-presentation rates also decreased, demonstrating enhanced treatment effectiveness.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Management
- Clinical Pathway Implementation
Background:
- Clinical pathways are structured multidisciplinary care plans designed to improve patient outcomes and resource utilization.
- Their effectiveness in pediatric emergency departments (EDs) for common acute conditions requires rigorous evaluation.
Purpose of the Study:
- To evaluate the overall effectiveness of clinical pathways in treating common acute pediatric conditions within an emergency department setting.
- To compare key outcomes including admission rates, length of hospital stay, and re-presentation rates before and after pathway implementation.
Main Methods:
- A before-and-after study design was employed, comparing data from 1996 (before pathways) to 1999 (after pathways).
- Data were collected on 2680 children managed without pathways and 2854 children managed with pathways for gastroenteritis, asthma, and croup.
- Main outcomes measured were admission to an in-patient bed, length of hospital stay, and re-presentation to the ED after discharge.
Main Results:
- Clinical pathway implementation led to a threefold reduction in admission rates (23.6% to 9.1%) and a twofold reduction in length of hospital stay (32.7 hours to 17.5 hours).
- The rate of unscheduled medical visits or re-presentation to the ED post-discharge decreased from 4.9% to 3.6%.
- Parental satisfaction was high, and no adverse events were reported in children managed via clinical pathways.
Conclusions:
- Clinical pathways are effective in stabilizing pediatric patients in the emergency department, leading to reduced admission rates and shorter hospital stays.
- The implementation of clinical pathways resulted in improved patient flow and decreased re-presentation rates, with high parental acceptance.
- Clinical pathways represent a valuable tool for optimizing care delivery for common acute pediatric conditions in emergency departments.
Abstract:
The aim of this study was to provide an evaluation of the overall effectiveness of using a number of clinical pathways in treating common acute paediatric conditions in an emergency department. This was a before and after study conducted on the effectiveness of three clinical pathways (gastroenteritis, asthma, and croup) in the emergency department of the Children's Hospital at Westmead, conducted over two separate yearly periods January to December 1996 and January to December 1999 representing before and after the introduction of clinical pathways in the emergency department. The main outcomes of the effectiveness of the pathways, namely admission to an in-patient bed, length of hospital stay and re-presentation after discharge from the ED were compared. Other outcomes of interest such as parental satisfaction and patient waiting times were also presented. Any deviation from a key clinical pathway process was reported. A total of 2854 children were managed by a clinical pathway compared to 2680 children managed before clinical pathways were introduced. The admission rate was reduced by threefold (9.1% compared to 23.6%) with a twofold reduction in length of hospital stay (32.7 h compared to 17.5 h). In 3.6% of children using a clinical pathway an unscheduled medical visit or re-presentation to the emergency department occurred after discharge, compared to 4.9% before the use of clinical pathways. No adverse events were reported in these children. In 76 cases deviation from a clinical pathway process was reported. High parental satisfaction was reported for clinical pathways throughout the study. Clinical pathways in this emergency department allowed rapid stabilisation of children, reducing admission rate, with a shortened length of hospital stay and few patients re-presenting after discharge and were well accepted by parents.
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