Standardization of Clinician Outcomes for Croup Using a Clinical Pathway

Area of Science:

• Pediatric Emergency Medicine
• Clinical Pathway Implementation
• Healthcare Quality Improvement

Background:

• Croup management protocols exhibit significant inter-hospital and inter-clinician variability.
• Standardizing care pathways is crucial for optimizing pediatric emergency department (PED) efficiency and patient outcomes.

Purpose of the Study:

• To assess clinician variability in managing pediatric croup using a standardized clinical pathway.
• To evaluate the impact of a clinical pathway modification on hospital admission rates and other key performance indicators.

Main Methods:

• Retrospective cohort study of children diagnosed with croup in a PED from 2018-2022.
• Generalized linear mixed models were employed to analyze interclinician variability in admission rates, length of stay, and unplanned return visits.
• Outcomes were examined in relation to patient race, ethnicity, and language.

Main Results:

• Minimal interclinician variability was observed in racemic epinephrine use, admission odds, and unplanned return visit odds.
• Black patients demonstrated significantly higher odds of admission (OR: 1.87), and patients in an 'other' racial group had higher odds of unplanned PED returns (OR: 1.94).
• Following a clinical pathway revision, quarterly admission rates decreased from 7.8% to 5.1% without significant changes in unplanned return visits or ICU transfers.

Conclusions:

• A standardized clinical pathway effectively minimized clinician-induced variation in croup management within the PED.
• Patient race was associated with disparities in admission rates and return visits, highlighting the need for equitable care.
• Pathway modification successfully reduced hospital admissions for croup, demonstrating the efficacy of targeted interventions in quality improvement.