Clinical pathways are a vital tool in providing patients with high-quality, standardized care, as well as improving the value of health care. But they are only helpful if physicians actually use them.
With a focus on a specific pathway in vascular surgery, Jeniann Yi, MD, received a $24,000 Clinical Effectiveness and Patient Safety Grant from UCHealth University of Colorado Hospital to increase utilization of clinical pathways within the electronic health records system.
“Electronic medical records are a great tool to help standardize the way we provide care and make it more efficient, especially when we can incorporate those pathways in a way that makes it easy to interface with our EMR as we’re providing this care,” says Yi, assistant professor of vascular surgery in the University of Colorado School of Medicine. “One of the things we’re trying to address with this grant is how to build pathways that are representative of the work we’re trying to do and the standard of care we’re trying to provide.”
Conducting research to build better care
Collaborating with leadership from the Department of Medicine’s Hospital Medicine Division and the Department of Emergency Medicine, Yi and others in the Department of Surgery plan to survey inpatient providers from different specialties on their perceptions and expectations of pathways created within the electronic medical records application AgileMD. The information gathered will be used to create a roadmap that can guide the development and successful implementation of future pathways.
“The point is to focus on what makes pathways useful for providers — what makes people want to engage with that pathway when they’re taking care of patients — as well as what specifically about an EMR-based pathway is helpful or potentially hurtful to users who would engage with it,” Yi says. “We’re trying to figure out how to incentivize providers to use these pathways to increase efforts to standardize care, as well as figure out if there are pitfalls we aren’t seeing when we build these pathways that are limiting their utilization.”
The other important thing about making the pathways useful to providers via EMR, Yi says, is that making such interfaces more useful and efficient for providers is a way to decrease time spent on EMR and potentially improve physician wellness. “We will be looking at efficiency outcomes when providers use pathways as well,” she says.
Preventing dangerous complications
Results of the study will have impacts throughout the CU School of Medicine, but in her specialty of vascular surgery, Yi is especially interested in creating a successful pathway to increase anticoagulation compliance in postoperative patients.
Taking blood-clot-reducing medicine after vascular surgery greatly reduces the risk of a dangerous condition called acute limb ischemia, a rapid decrease in lower limb blood flow that can result in amputation or even death if not treated properly. A standardized plan for postoperative care can help ensure that patients stay on track with medications that keep them safe.
“We estimate that roughly 350 patients each year are admitted for an ischemic event and would be appropriate for this pathway,” Yi says. “Pathway users would include emergency medicine providers and surgical consultants looking to appropriately diagnose and triage ischemic limb patients.”
Consistent level of care
Outside of her specialty, though, Yi knows the importance of creating pathways that are not only useful to providers, but are designed in such a way that providers want to engage with them.
“Within surgery there are a lot of evidence-based care pathways after specific operations that are a benchmark of care,” she says. “We want to make sure that for every patient who had that surgery, they’re following this pathway so they receive this benchmark of care. It reduces errors, it reduces deviations from those pathways, and it helps provide a consistent level of care, no matter who is taking care of that patient.”