Clinical Pathways in Pediatric Medicine – PediaCast CME 103

Posted by on

Podcast: Download

Subscribe: RSS

Show Notes

Description

  • Drs Roopali Bapat and Berkeley Bennett visit the studio as we consider clinical pathways in pediatric medicine. How are pathways developed, implemented, evaluated, and updated? Where are they useful? What are their benefits… and pitfalls? Tune in to find out!

Instructions to obtain CME/CE Credit

  1. Read this information page.
  2. Listen to the podcast.
  3. Complete the post-test at Nationwide Children’s CloudCME.
  4. Please Note: CME credit expires 3 years from this episode’s release date

Topic

  • Clinical Pathways in Pediatric Medicine

Presenters

Learning Objectives

At the end of this activity, participants should be able to:

  1. Understand the process for developing a clinical pathway.
  2. Identify how clinical pathways are implemented and maintained at Nationwide Children’s Hospital.
  3. Describe how clinical pathways standardize care, enhance patient safety, improve patient outcomes, improve cost-effectiveness, and improve treatment efficiency.
  4. Know where to find clinical pathways from Nationwide Children’s Hospital.

Links

Disclosure Statement

  • No one in a position to control content has any relationships with commercial interests.

Commercial Support

  • Nationwide Children’s has not received any commercial support for this activity.

CME/CE Information

  • In support of improving patient care, Nationwide Children’s Hospital is jointly accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for the healthcare team. (1.0 ANCC contact hours; 1.0 ACPE hours; 1.0 CME hours)
  • Nationwide Children's Hospital has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credits. Approval is valid for 2 years from the date of the activity. PAs should only claim credit commensurate with the extent of their participation.
  • As a Jointly Accredited Organization, Nationwide Children's Hospital is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. Nationwide Children's Hospital maintains responsibility for this course. Social workers completing this course receive 1.0 continuing education credits.
  • Continuing Education (CE) credits for psychologists are provided through the co-sponsorship of the American Psychological Association (APA) Office of Continuing Education in Psychology (CEP). The APA CEP Office maintains responsibility for the content of the programs.

Contact Us

  • CMEOffice@nationwidechildrens.org

 

Episode Transcript


[Dr Mike Patrick]
This episode of PediaCast CME is brought to you by the Clinical Pathways Program at Nationwide Children's Hospital. 

Hello, everyone, and welcome once again to PediaCast CME. It is a continuing medical education podcast for health care providers.

This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. I want to welcome all of you to the program.

It's episode 103, and we are calling this one Clinical Pathways in PediaCast. So not only welcome to PediaCast CME but also welcome to 2025. And as we stand here at the beginning of the year, I am really excited because we have lots of terrific content planned for you this year.

Here, of course, with our continuing medical education episodes, but we also have a new year of expanded content on plain PediaCast without the CME, which is our podcast for parents and families over at PediaCast.org. What really has me excited is a new podcast that we are launching later this month. In fact, the first episode is going to drop on January 21st, 2025.

And that podcast is called FAMEcast, F-A-M-E-C-A-S-T. And it's available at FameCast.org. Now, FAMEcast will target physicians in academic medicine, not only pediatrics, but all of health care.

And it's sponsored by the Center for Faculty Advancement, Mentoring and Engagement at The Ohio State University College of Medicine. So, the goal of our new podcast is to support faculty members at Ohio State and beyond as they navigate a career in academic medicine. Our first three episodes will give you a sense of where we are headed with this podcast.

Episode one is an introduction to mentoring and coaching. Episode two will be creating a professional mission statement. And then episode three is on work-life harmony.

And you'll notice I didn't say balance. And if you want to know why I chose the word harmony instead of balance, stay tuned and check out episode three when that one drops in February. And we have lots more planned after those first three.

You can find FAMEcast again over at FameCast.org. It'll soon be available wherever you get your other podcasts. Simply search for FAMEcast.

And again, that's F-A-M-E-C-A-S-T, all one word. You can again search that wherever you get your podcasts and also check out FameCast.org. I'll have a link to it in the show notes as well.

So, you can find it super easy over in the show notes for this episode 103 over at PediaCastCME.org. Alright, so how are we ringing in the new year on our CME program? Well, we are going to take a look at clinical pathways, including how they're created, when and where they should be used, and by whom, how they should be evaluated and updated, and their benefits and limitations.

And also, creative ways that can be adapted for primary care and other outpatient practices. Of course, in our usual PediaCast fashion, we have a couple of terrific guests joining us this week. Dr. Roopali Bapat is a neonatologist at Nationwide Children's Hospital, and Dr. Berkeley Bennett is with Emergency Medicine at Nationwide Children's. Both have extensive experience creating, implementing, evaluating, and updating clinical pathways in pediatric medicine. So, they will be here shortly. Before they get here, though, let's cover some quick reminders.

After listening to this episode, be sure to claim your free Category 1 credit. Really easy to do. Just head over to the show notes for this episode at PediaCastCME.org.

You'll find a link to the post test in the show notes. Follow that link to Cloud CME, click on the materials tab, and take and pass the post test, and the Category 1 credit is yours. Really easy.

We offer credit to many pediatric professionals, including doctors, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by many professional organizations, it's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements. Of course, you want to be sure the content of the episode matches your scope of practice.

This particular episode really should match everyone's scope of practice because clinical pathways are multidisciplinary in nature and really pertain to every field of medicine. Complete details on the podcast and how to get to CME and all of that is available at our landing site, PediaCastCME.org. Also, I want to remind you the information presented in our podcast is for general educational purposes only.

We do not diagnose medical conditions or formulate treatment plans for specific individuals. Also, your use of this audio program is subject to the PediaCastCME Terms of Use Agreement, which you can also find at PediaCastCME.org. So, let's take a quick break.

We'll get our expert guests settled into the studio, and then we will be back to talk about clinical pathways in pediatric medicine. It's coming up right after this. Dr. Roopali Bapat is a neonatologist at Nationwide Children's Hospital and an Associate Professor of Pediatrics at The Ohio State University College of Medicine. She serves as Medical Director of Quality and Safety for the Neonatal Network and Medical Co-Director of the Clinical Pathway Programs at our hospital. Dr. Berkeley Bennett is an Emergency Medicine Physician at Nationwide Children's and an Associate Professor of Pediatrics at Ohio State. She serves as the Director of Emergency Medicine Performance Improvement and was a recent Co-Medical Director of the Clinical Pathway Programs at our hospital.

And in that role, she facilitated the creation of 40 clinical pathways during her tenure. Both have a passion for developing, implementing, and updating clinical pathways, which is the topic of our conversation today. But before we jump into that, let's offer a warm PediaCast welcome to our guests, Dr. Roopali Bapat and Dr. Berkeley Bennett. Thank you both so much for stopping by today.

[Dr Roopali Bapat]
Thank you so much, Mike, for having us today. It's our pleasure to be here.

[Dr Berkeley Bennett]
Yes, thank you, Mike. I'm excited to be here.

[Dr Mike Patrick]
Yes. And I am excited as well and really appreciate both of you taking time to spend with us. I know it was a little bit of a challenge.

We had to reschedule this one a couple of times, and your patience is so much appreciated. So, Berkeley, let's start with you. I think just the foundation of, you know, what exactly is a clinical pathway?

I think a lot of clinicians have an idea of what a pathway is, but it may not be spot on. So, can you please just let us know what exactly is it we're talking about?

[Dr Berkeley Bennett]
Sure. The Nationwide Children's Hospital definition of a clinical pathway is a multidisciplinary plan of care that translates guidelines, evidence, and expert opinion onto local infrastructure and processes. So, to illustrate further, I will use the example of our febrile infant pathways.

The American Academy of Pediatrics reviewed 40 years of research to develop a detailed guideline for the evaluation and treatment of a young baby with a fever. Our clinical pathway program collaborated with local infectious disease experts and frontline providers to combine recommendations from the national guideline with expertise and knowledge of local infections and created pathways that clearly outline how to best care for a young baby with a fever at our institution. So, pathways are designed to be complete but quick and easy to read references to help medical teams care for patients in real time.

Pathways also call out opportunities for shared decision-making with parents, emphasizing the critical role that parents play in the health of their child. There are pathways specific for outpatient clinics, urgent cares, emergency departments, and inpatient units to ensure that the recommendations are optimized for each clinical setting. Not only do pathways promote the best delivery of health care, but they standardize the care so that we're providing the best quality to every patient.

[Dr Mike Patrick]
And I think, you know, these are fairly new and have exploded in terms of the number of them. And so, when I was training, and I'm sure, Berkeley, when you were training, there weren't clinical pathways. But they're obviously useful.

Why exactly are they so important?

[Dr Berkeley Bennett]
Well, they help providers. Well, they provide evidence-based, high-quality, high-value care. So, they put everything there so that providers can do the very best for their patients.

[Dr Mike Patrick]
And it's also going to be important, and we'll get into this a little later, but I would imagine this isn't necessarily a cookbook recipe, correct? Like, there are situations where we still have to use our clinical judgment.

[Dr Berkeley Bennett]
Absolutely, 100%. They are certainly guidelines, but we really want providers to use their best judgment in the setting when they're caring for the patient.

[Dr Mike Patrick]
Now, you mentioned infants with fever. What are some other examples of clinical pathways in pediatric medicine?

[Dr Berkeley Bennett]
So, well, right now, we have 100 clinical pathways from nationwide children that are available. They represent a broad spectrum of pediatric conditions, from common diseases such as an ear infection to rare diseases such as infections of the heart. We also have pathways that provide guidance on how to evaluate and manage injuries, how to safely provide sedation during procedures, and the process for life-saving interventions such as endotracheal intubation.

[Dr Mike Patrick]
And, you know, something else, because we're a teaching hospital, we have a lot of residents from other institutions and even other specialties, emergency medicine, family practice, for example, that rotate through our hospital. And having those pathways not only ensures that each patient is going to get the best care, you know, regardless of where a trainee is coming from or their past experiences, but it really does ensure, you know, good quality care all across the board. And that really aids in teaching, not only in providing care to the patient, but also then that resident is exposed to the proper ways that we treat things.

Yes, absolutely. And Roopali, then, why is a multidisciplinary approach important for clinical pathways? Yeah.

[Dr Roopali Bapat]
So, as a member of the healthcare team, I really think of practicing modern, high-quality medicine as a team sport. So, for example, when a child is in the emergency room or maybe admitted to the hospital or even at a routine clinic visit, right, the child and the family are cared for by the nurses or maybe a pediatrician, one or more subspecialists as needed. Other healthcare professionals such as dietitians, respiratory therapists, occupational therapists, social workers, pharmacists, psychologists, so they may be involved in the child's care as well.

Our goal through the clinical pathway is for this multidisciplinary team to provide the best practices, not only in each individual care setting, but across care settings as well. So, when a patient from the ED gets admitted to the pediatric floor, both teams collaborate to align their pathways so that our patients and families receive consistent and seamless care.

[Dr Mike Patrick]
Yeah, that's a really good point. If you had one pathway for the emergency department and a different pathway for hospital pediatrics, then that would be really confusing to the parents. And yet, from the provider's standpoint, even though pathways are different, both of them might be evidence-based and completely acceptable, but that would sure be confusing for parents, I would imagine.

So, it is a good idea. And then, the more people that you get looking at it from different lenses, as you said, from the physician lens, but then also nursing and social work and pharmacists, all of the folks involved in patient care, it's really good to get their input. Because they may have a point that someone else may not have thought of, and so you really do get the best care when you have a multidisciplinary approach like this, rather than just one person writing pathways and saying, my way or the highway, right?

[Dr Roopali Bapat]
Yes, so the one-team approach is extremely important.

[Dr Mike Patrick]
Yes, yeah, absolutely. And then, how does evidence fit into this, then? How does evidence-based research fit into the development of a clinical pathway?

And then, I would imagine, evidence changes. We saw that during the pandemic, when recommendations changed because new studies were coming out. So, I imagine that evidence-based research is going to be important, not only for the development of pathways, but to maintain them as well.

[Dr Roopali Bapat]
That's a great question. So, the medical research and the evidence that develops from the medical research, it really is the impetus for the development of our clinical pathways. The rapid pace at which new evidence emerges can sometimes be so overwhelming, right?

Making it impossible for each individual provider to stay updated without adequate support. And this might also lead to significant variation in care. We've seen that in the past, before clinical pathways were commonly used, it took about 17 years until new evidence was implemented at standard patient treatments.

So, even after a medical organization published a national guideline, it could take many years until patients received the recommended care. So, to try to speed up this process, clinical pathways started in the 1980s. And I want to emphasize that pathways are meant to complement clinical judgment.

They are not meant to be prescriptive. And as you mentioned, we definitely want to avoid the cookbook medicine, right? So, the pathway team members, which includes a multidisciplinary group of experts, review the available evidence for the management and treatment of certain medical conditions.

The team also considers the local processes and develops an evidence-based algorithm that describes the best practices.

[Dr Mike Patrick]
And so, really important to use evidence. And I love that this improves the translation of new research into patient care. 17 years, I hadn't realized that it was really that long.

And when you think about it, it's because, you know, someone does research. They, especially before social media and the internet, they would publish their research. It would get published in a journal.

Someone would have to read that journal and then decide, oh, maybe I should be doing it this way. But, you know, a small percentage of folks in a particular specialty actually read all the journal articles. I do think that in the days of social media now, you know, it's a great tool for folks to raise awareness of their research and to get their ideas out there.

But even better is having a group at a hospital who's looking at their current research. Like, that's their job. We're looking at all this new stuff coming out and implementing it right away, as makes sense.

You know, we have to always take research in the context of all the other research that's been done because one particular study is not necessarily a gold standard. Sometimes they are, but, you know, not very often. We have to look at the sum of things.

So having a whole multidisciplinary committee looking at the sum of things and kind of updating it as we go along, that really is best practice for patient care and then for patient outcomes as well. Roopali, I did want to ask, so there is consensus and consistency on pathways within an institution. What about from one institution to another?

We have a pathway that's very different from a pathway at another pediatric hospital that's also, you know, considered a top hospital.

[Dr Roopali Bapat]
So, in general, the baseline evidence should not change. However, what might be different is based on the local processes. So, it is important to adapt the evidence that's available to the local processes.

So that might be some variation that you might see between the hospitals, but the general premise of management and treatment should not change.

[Dr Mike Patrick]
Yeah. And I would imagine for things that are major, where there really is national consensus that it's probably not going to change much from one institution to another. But where there are local practice patterns of, you know, maybe a steroid is given twice a day at one place, but it's very standard to do it once a day at another place.

So much so, and I've seen this happen, where someone who practices at another place comes to your place and tries to do it like they did it. And they, you know, they get, I wouldn't say yelled at, but, you know, they get pushback for sure. But there are multiple ways.

I mean, does it really matter at the end of the day? There may be some nuances of why given a steroid, you know, twice the dose once a day or half the dose twice a day. At the end of the day, it probably doesn't make that big of a difference for that particular thing.

But there are other things where it would make a big difference. So, Roopali, can you then describe the process of actually developing a clinical pathway at our hospital? What are some resources that are available here at Nationwide Children's Hospital?

[Dr Roopali Bapat]
Sure. So, to facilitate the development and utilization of clinical pathways, we have a lot of resources and support at Nationwide. So, to start with, we have a great clinical pathway program team, which includes a program manager, three coordinators, five medical directors from surgery, emergency medicine, neonatology, and hospital pediatrics.

And this team is led by our Associate Chief Medical Officer, Dr. Ryan Bodhi, and is supported by our hospital's leadership. In addition, we are also supported by our electronic health record clinical tool development, data analytics, and business intelligence. So, the first step in the development of a pathway is the development of the pathway algorithm itself.

The pathway algorithm and a detailed document is developed based on the review of the current evidence, which we just discussed. And once this pathway is developed, the pathway undergoes a rigorous peer review process, and it is then published. So, in terms of our program's overall productivity and an ever-growing interest in pathway development throughout our hospital, we have recently reached a milestone of publishing 100 pathways on Anchor.

[Dr Mike Patrick]
Yeah, that is really impressive that we have 100 clinical pathways, and they are available for folks to take a look at. And we'll talk a little bit later in the program of how folks can access those pathways in case it's one that you might want to use in your practice. But once the clinical pathways are developed, how then are they put into practice and maintained?

[Dr Roopali Bapat]
That's a great question again. So, the pathway development, the implementation, the maintenance, and review, they actually go through a continuous process improvement iterative cycle. So once the clinical pathway document is developed, the next step is integration of the pathway into the electronic health record.

So various Epic tools such as, you know, order set or a note helps providers utilize appropriate pathways in appropriate patients. Each pathway will have specific electronic tools that physicians can use to order the best tests and to prescribe the most effective treatments. There are also electronic tools for the nurses and for other staff to monitor the patient and to escalate care quickly when it's needed.

So, we use implementation science methods and behavioral economics that help us change any old habits that we all have as human beings, right? So, in addition to this, we also develop outcome process and balancing metrics for our pathways so that we can track patient outcomes. So, after the pathway is implemented, we collect data to measure our performance, and we use quality improvement methodology to achieve the desired result.

We are working towards a goal of developing pathway utilization and outcomes dashboard for all our pathways. In addition, our teams revise the pathways when new evidence becomes available, or each pathway goes through a review cycle every three years.

[Dr Mike Patrick]
For each pathway, is there a particular lead person who might be looking out for new evidence? So, you mentioned that there's, you know, it definitely gets reviewed every three years. But, you know, a big study may come out and if you don't have someone who it's their job to be looking for new things coming out.

I would imagine like the leader of a pathway might be that person. Is that how the group is set up?

[Dr Roopali Bapat]
Yes. So, for every pathway, ideally, we have a pathway champion in addition to this big multidisciplinary team. So generally, the onus is on the pathway champion and the multidisciplinary team.

However, this pathway is peer reviewed, as I mentioned. So, every physician or a provider is involved and has had provided input for the pathway development and review.

[Dr Mike Patrick]
Yeah. And I would imagine that the champion, that's something that they could use for promotion in academic medicine as well. Like, hey, I made this pathway.

It got peer reviewed. It was put into practice. Is that something that promotion and tenure committees are interested in?

[Dr Berkeley Bennett]
Yes, absolutely. It's really a nice way because we can use them as educational activities and can reach a very broad audience, especially pathways that are posted on our externally facing site have been accessed from all over the world, all over the United States. And so, we really get to share a lot of information that way.

And so absolutely, that is valuable for promotion, too.

[Dr Mike Patrick]
How do clinical pathways enhance patient safety, Berkeley?

[Dr Berkeley Bennett]
Well, as Dr. Bapat has explained, pathways are developed by a multidisciplinary team. So, the expertise of each team member is critical to making sure that patient safety is optimized. An example of this is the emergency department pathway for procedural sedation.

We utilize the expertise of doctors, nurses and pharmacists to provide guidance on who is safe to be sedated in the emergency department, what medications are safe and effective and details about how to monitor and keep the patient safe.

[Dr Mike Patrick]
And then do we also improve efficiency in having pathways?

[Dr Berkeley Bennett]
Yes, absolutely. So, each pathway includes information on how to recognize and evaluate a specific condition and how to manage it all in one document. So, no need to look up textbooks or ask a friend.

It's all right there. And so, while each pathway is consistent with national guidelines, it's also specific for care at Nationwide Children's Hospital. So, this helps teams to navigate the care within our hospital setting.

[Dr Mike Patrick]
Do you find that there's a difference between younger physicians and older physicians in terms of using pathways? I would imagine that the younger physicians who had pathways right out of the gate, like that's their first thought is, oh, let me go look at the pathway. And older physicians like ourselves who had trained without pathways and work, you know, maybe for decades without pathways, like it's kind of a culture change to think I need to go to the pathway first rather than I know what I'm doing.

[Dr Berkeley Bennett]
Absolutely. And so, we like to always remind people that pathways, we have kind of an 80-20 rule. Pathways should be applicable to 80 percent of the patients with that disease.

So, it's not everybody. And so, it's not certainly something you absolutely have to adhere to because you can use your clinical judgment. And so, it's really a balance between using all of that guidance and then also using your judgment on what's best for that patient.

Yes, we've noticed that some of the older people are not used to it. So, they're like, oh, you know, the pathway is telling me what to do. And that's not really exactly it.

It's making recommendations, but ultimately the provider has to decide what's best.

[Dr Mike Patrick]
But at the same time, when we can show that the pathway actually improves patient outcomes, that's a pretty good argument for using them. So, you know, I think that those of us who train without pathways, it is important to remember to take a look at them and just check yourself and make sure that you really are up to date and providing the best medicine for your patient. So, I'm assuming that clinical pathways improve patient outcomes.

Is that true, Roopali?

[Dr Roopali Bapat]
Absolutely. So, the evidence that supports the impact of clinical pathway is in reducing variability. So irrespective of whether the patient gets admitted at 2 a.m. in the morning or 2 p.m. in the afternoon, and irrespective of the staff caring for the patient, the goal is for the right care to the right patient at the right time. So, there was a Cochrane review of 27 studies involving over 11,000 participants showed reduction in the length of stay and hospital costs for the clinical pathway groups compared with usual care. So increased use of clinical pathways has also been shown to increase patient satisfaction. It improves clinical outcomes, including reducing mortality and complications across different types of pathways and conditions.

So, while the evidence generally supports the effectiveness of clinical pathways in patient outcomes improvement, the success of implementation can depend on various factors, right? It could depend on the condition that's being treated, compliance to the pathway, which you just talked about now, and the involvement of multidisciplinary teams.

[Dr Mike Patrick]
And those are also such important things, patient safety, patient outcomes, patient satisfaction, efficiency. What about cost? Do clinical pathways improve cost effectiveness?

And if so, how does that happen?

[Dr Roopali Bapat]
Yeah, so we all know that healthcare is so expensive, especially inpatient hospital stay. So, studies have shown that when you utilize clinical pathways, it improves cost effectiveness by various means, by reducing unnecessary diagnostic testing, by reducing unnecessary procedures and unnecessary interventions. So, pathways can improve resource utilization by streamlining care processes and reducing redundant or inefficient practices.

So, there are various studies that have found that clinical pathways could lead to cost savings through reduced length of stay, fewer complications, and improved adherence to evidence-based practices. So, the reduction in the hospital length of stay can actually decrease a loss of income that the families might experience during a hospitalization. So overall, while the implementation of clinical pathways might require an initial investment of time and resources, the long-term benefits outweigh the costs, contributing to better value in healthcare delivery.

[Dr Mike Patrick]
Yeah. And Berkeley, we mentioned that pathways also improve patient and family satisfaction. How does that happen?

[Dr Berkeley Bennett]
So, the pathways standardize care so that patients and families can be confident that every child is getting the care that they need. Often as I'm discussing plans with families, I refer to pathways to illustrate the expert consensus for the recommendations and the streamlined plan of care. It also gives me an opportunity to discuss with parents why we do or do not recommend certain tests or treatments and hear their perspectives so we can work together for the best plan for their child.

[Dr Mike Patrick]
Yeah. What about the physician satisfaction and the provider satisfaction? Have you had feedback on what folks think of using pathways?

[Dr Berkeley Bennett]
Yes. Overall, people seem to really like them. And it's so nice to be able to go there, get all the information you need in one stop.

You know, I get, as you mentioned before, some of the older physicians may be like, oh, you know, we shouldn't just rely on pathways. And so, there's a little bit of getting used to it there. But overall, I think people really like them.

And it really helps to just say, this is what we do here. This is how we work this up. This is how we treat it.

And everybody can be on the same page.

[Dr Mike Patrick]
You know, and as we think about pathways, improving patient care, safety outcomes, you know, all the all the things. Another aspect of it, I would imagine, is that it decreases the incidence of malpractice lawsuits. And maybe I'm not.

I mean, it would just seem that that would be an effect, because, you know, if you're doing things the way that your institution does them in a standardized way, it's a little harder. Then to criticize the care that you're giving is have we seen that in practice? Has anyone looked?

Is there any research out there that looks at malpractice cases, maybe being less at places that have clinical pathways?

[Dr Berkeley Bennett]
I think that's an excellent question. I don't know if there's any informal studies looking at that, but it makes sense because, you know, when you think about why, you know, when lawsuits happen and how you defend your care, a big question is, are you using are you aligning with standardized practices and best recommendations? And so, if you're following a pathway, that's what they are.

And so, I would think that would be very helpful in those situations. Yeah.

[Dr Mike Patrick]
And again, for young physicians out there, maybe there's a research project and you could do it in collaboration with a law school. Maybe there's maybe there's a law student that would want to collaborate on that. That's a great idea.

Throwing out ideas. As I think about clinical pathways, hospitals really come to the forefront of my mind. But I also have been in my past, I practiced in a pediatric practice with multiple providers.

And even within a primary care practice, there can be differences in how people treat things. And then that becomes an issue when families, you know, compare notes with someone who sees a different doctor in that practice, and they have care done a different way. Or your doctor's schedule is full, and you see the partner and you're used to your physician treating something in a particular way and the partner's doing it in a different way.

So, I could see that there might be advantages to using clinical pathways in primary care practices. Is that something, Berkeley, that that is a possibility?

[Dr Berkeley Bennett]
Oh, absolutely. We have a lot of our outpatient clinical pathways are used specifically for that as you know, so that primary care practices can really all follow the same guidelines. Something that we found really valuable is that clinical pathways can also be utilized in community emergency departments.

And why this is so important is that over 80% of children are cared for in community emergency departments. And they may be seen by providers who aren't necessarily trained as pediatricians or trained specifically in pediatrics. And so, it's really valuable for them to have all that expert consensus and recommendations right at their fingertips.

Often this can prevent the need for them to call out to a subspecialist because they already know the recommendations right there. It may prevent the need for transferring the patient to a tertiary care hospital and can really just augment the care that they're getting at these settings.

[Dr Mike Patrick]
So Roopali, if I'm a practicing pediatrician or other physician, and I want to find a pathway, you know, maybe I don't have the bandwidth to come up with a pathway on my own for my office. And I really would love the input of the experts in a particular disease process. How can I find trusted and validated pathways that I can have some comfort in, that it's evidence-based, someone is maintaining that pathway, someone's changing it when it needs to be changed?

How do I find those?

[Dr Roopali Bapat]
Sure. So, for folks that have access to Anchor, our clinical pathways can be found on Anchor, our internal NCH site. But what I find especially exciting is that our pathways are now also on an external site.

So, they are available on the internet. So, if you just Google NCH clinical pathways, you'll see them. They're just organized by care setting.

So, any practicing community physician can access our clinical pathways.

[Dr Mike Patrick]
Yes.

[Dr Roopali Bapat]
So, we've looked at the data related to it. And our data shows that our NCH pathways have been viewed over 600 times per month by almost 14 countries worldwide, including 35 states in the US and three provinces in Canada. So really, anybody has access to our clinical pathways.

[Dr Mike Patrick]
And I will also put a link in the show notes for this episode to the clinical pathways at Nationwide Children's Hospital, the ones that are on the external sites that anyone can access. I'll put a link to that in the show notes for this episode, which is pdacastcme103. And so, you will be able to find those, yes, very, very easily.

So, then Roopali, let's say that I am a provider at Nationwide Children's Hospital. There is, you know, something in my field of expertise that I would love for there to be a pathway about, but there isn't one. How do I go about developing a new pathway?

Who do I contact?

[Dr Roopali Bapat]
Yeah, I'm actually glad you asked this question. So, the clinical pathway team reviews all the requests. So, if anybody is interested in developing a clinical pathway, and when they reach out to us, we plan, we prioritize and support pathways every year.

However, we also want to be agile. So, if there is any clinical need that surfaces and a new pathway has to be developed due to high value to the patients, we are able to do so as well. I also want to highlight our NCH Clinical Pathway Academy.

So, this course provides guidance to providers to create and implement clinical pathways. And at the end of the academy, each participant presents their pathway, and they receive a certificate in recognition of their accomplishment. Physicians also have an opportunity to work on QI projects related to the pathway.

So, these pathway-related QI projects are eligible for Part IV MOC credits, which is really nice. Yes.

[Dr Mike Patrick]
Yeah, that really is nice because those Part IV credits, especially in pediatrics on our maintenance and certification, can be sometimes hard to find. And that's really where we are doing something to improve our practice. And so clinical pathways certainly count for that.

And I would imagine then that the committee at the hospital knows how to apply for the MOC credit. So, you can't just make a pathway and claim credit. It has to be done through an official channel.

[Dr Roopali Bapat]
Yes. So once the pathway is developed and once opportunities are identified on where to improve, so that work, so that QI work is the one that obtains them Part IV MOC credits.

[Dr Mike Patrick]
Yes.

So, I do want to remind folks that we have lots of helpful links in the show notes. We have a link to neonatology at Nationwide Children's and emergency medicine, since that's where our two guests are from. And then we will have a link to clinical pathways program at Nationwide Children's Hospital, where you can find many, many clinical pathways that you could potentially use at your institution or in your practice.

Of course, if you're at Nationwide Children's, we have additional pathways that are available on Anchor, and I'll have links to the clinical pathways in the show notes for this episode 103 over at pediacastcme.org. We also have a link to the clinical pathways program in children's hospitals, which is just a resource in pediatrics that was published that kind of looks at clinical pathways, how they get developed and encourages institutions to use them from the American Academy of Pediatrics. So that journal article in pediatrics, we'll put a link to that in the show notes as well.

So, folks can have that as a resource. And then finally, I wanted to remind everyone that starting later this month here, January 2025, we are going to have a new podcast through the College of Medicine called FAMEcast. And this is a faculty development podcast from the Center for Faculty Advancement, Mentoring and Engagement at The Ohio State University College of Medicine.

I will be hosting that. And so, I'll encourage folks to check out this new podcast that's coming out. Actually, our first episode will drop on January 21st.

So, mark your calendars and we'll put a link to FAMEcast in the show notes again for this episode. So once again, Dr. Roopali Bapat with Neonatology and Dr. Berkley Bennett with Emergency Medicine. Thank you both so much for stopping by today.

[Dr Roopali Bapat]
Thank you so much, Mike, for having us and giving us the opportunity to increase awareness related to our pathways. It's been a great conversation with you.

[Dr Berkeley Bennett]
Yes, thank you so much.

[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast CME a part of it. Really do appreciate that. Also, thanks to our guests this week, Dr. Roopali Bapat with Neonatology and Dr. Berkley Bennett with Emergency Medicine, both at Nationwide Children's Hospital. Don't forget, you can find us wherever podcasts are found. We are in the Apple Podcast app, YouTube Podcasts, iHeartRadio, Spotify, SoundCloud, Amazon Music, YouTube, the regular YouTube, and most other podcast apps for iOS and Android. Our landing site is PediacastCME.org.

You'll find our entire archive of past programs there, along with show notes for each of the episodes, CME information, our terms of use agreement, and a handy contact page if you would like to suggest a future topic for the program. Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show, and we love connecting with you on social media.

You'll find us on Facebook, Instagram threads, LinkedIn, X, simply search for PediaCast. You've listened to the podcast. Now be sure to claim your free Category 1 Continuing Medical Education credit.

Really easy to do. Just head over to the show notes for this episode at PediacastCME.org. You'll find a link to the post test in the show notes.

Follow that link to Cloud CME, click on the materials tab, and then take and pass the post test, and the Category 1 credit is yours. Super easy, right? And again, we offer credit to not only physicians, but also nurses, nurse practitioners, physician assistants, pharmacists, psychologists, social workers, and dentists.

Of course, you'll want to be sure the content of the episode matches your scope of practice. Complete details are available at PediacastCME.org. And then don't forget about our evidence-based podcast for parents, Plain PediaCast without the CME.

Lots of pediatricians and other medical providers tune in as we cover pediatric news, answer listener questions, and interview pediatric and parenting experts. Shows are available at the landing site for that podcast, Pediacast.org. Also available wherever podcasts are found, simply search for PediaCast.

Thanks again for stopping by, and until next time, this is Dr. Mike saying stay informed, keep it evidence-based, and take care of those kids. So long, everybody.
 

 

 

This entry was posted in PediaCast CME and tagged , , , , , , , , by Dr. Mike. Bookmark the permalink.

Comments are closed.