Development of a Web-Based Nonoperative Small Bowel Obstruction Treatment Pathway App.

Area of Science:

• Surgical Innovation
• Health Informatics
• Clinical Pathways

Background:

• Adhesive small bowel obstruction (SBO) poses significant management challenges.
• Current management strategies may lack standardization, leading to variable patient outcomes.
• Electronic health records (EHRs) offer potential for optimizing clinical decision-making and pathway implementation.

Purpose of the Study:

• To describe the development and implementation of an electronic clinical pathway for adhesive SBO.
• To evaluate the early outcomes of patients managed with this electronic pathway.
• To compare outcomes between electronic, paper-based, and no-pathway management of adhesive SBO.

Main Methods:

• An electronic pathway for adhesive SBO was developed within an EHR system.
• Patients admitted with adhesive SBO were retrospectively analyzed across three groups: no pathway, paper pathway, and electronic pathway.
• Key outcomes including length of stay (LOS), time to surgery, readmission, and bowel resection rates were compared using statistical analyses.

Main Results:

• Median length of stay (LOS) was significantly lower in both paper and electronic pathway groups compared to the no-pathway group (p=0.04).
• The electronic pathway involved 46 patients, the paper pathway 93, and the no-pathway group 101 patients.
• No significant differences were observed in readmission rates, surgery rates, time to surgery, or bowel resection rates across the three groups.

Conclusions:

• Implementing an electronic, evidence-based clinical pathway for adhesive SBO is feasible.
• Both electronic and paper-based pathways demonstrated a reduction in hospital LOS for adhesive SBO patients.
• Further research may explore optimizing pathway elements to improve other critical outcomes.