3 - Clinical Pathway Programs in Children’s Hospitals: A North American Survey Study

Poster Number: 3
Publication Number: 3.414

Leigh Anne Bakel, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States; Jacinda M. Nicklas, University of Colorado School of Medicine, Aurora, CO, United States; Amanda Dempsey, University of Colorado, Aurora, CO, United States; Sunitha V. Kaiser, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Sanjay Mahant, The Hospital for Sick Children, Toronto, ON, Canada; Lalit Bajaj, University of Colorado Denver, Denver, CO, United States; Sonja I. Ziniel, University of Colorado School of Medicine, Aurora, CO, United States

Background: Clinical Pathways assist the implementation of best evidence into practice, improving care and health outcomes for patients. Pathways can reduce unintended variation in care, reduce unnecessary resource use, and improve efficiency. However, little objective information measuring their impact is available.

Objective: To determine the prevalence of Clinical Pathway programs and describe characteristics, similarities, and differences across programs in a North American sample of hospitals.

Design/Methods: We conducted a multi-center, cross-sectional, web-based survey through Pediatric Research in the Inpatient Setting (PRIS, a research network of hospitals providing inpatient pediatric care) in May 2021. We sampled clinical administrators who oversaw development of clinical pathways at each hospital. We used descriptive statistics to describe the prevalence of Clinical Pathway programs among PRIS institutions and Fisher’s exact tests to describe similarities and differences between programs by hospital characteristics.

Results: Eighty-one PRIS hospitals responded to the survey (73% response rate). Freestanding children’s (48%, n=39/81), academic (60%, n=43/72), teaching hospitals (96%, n=78/81) made up the largest proportion of survey respondents (Table 1). Freestanding children’s hospitals were significantly more likely to have a Clinical Pathways programs compared to other children’s/community hospitals (48%, 41%, 11%, p=0.012). Asthma was the most frequently used pathway (12%, n=54) (Table 1). PRIS hospitals that reported having only 1-10 pathways were significantly less likely to have a Clinical Pathways program (p < 0.001).
 
The majority of hospitals had a Clinical Pathways program (63%, n=50) with average program initiation in 2014 (IQR 2010-2016). Most programs were hospital-wide (70%, n=35). Forty-six percent of programs were not funded. The programs without funding had fewer pathways than those with even part-time funding (p < 0.001).
 
Most programs had a multidisciplinary Pathway Development team that “usually/always” included hospitalists, pharmacists, nurses, specialists, emergency department providers, and the electronic health records team (Figure 1). Dissemination efforts included emails and in-person education to involved groups (Figure 2).Conclusion(s): Over half of this North American sample of hospitals had a clinical pathways program. Freestanding children’s hospitals were more likely to have a clinical pathways program and those with program funding had significantly more pathways than those without funding.
Table 1: Demographics of Responding PRIS Hospitals and Characteristics of Clinical Pathway ProgramsBackground Demographics of Responding PRIS Hospitals (n=81 unless otherwise noted) and Characteristics of Pathway Programs at PRIS Hospitals (n=50 unless otherwise noted)
Figure 1: Team Members Included by Pathway Program in Pathway Developement TeamThis figure illustrates how often different team members are included in Clinical Pathway development teams across different children's hospitals