Postoperative Clinical Pathways for Outpatient Arthroplasty of the Hip and Knee

BACKGROUND Multidisciplinary tumor boards play a pivotal role in the patients -centered clinical management and in the decision-making process to provide best evidence -based, diagnostic and therapeutic care to cancer patients. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key-point to reach a successful oncology team and implement a network among health professionals and institutions. This need is stronger than ever in a Covid-19 pandemic scenario. OBJECTIVE This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients’ outcomes, and patients satisfaction METHODS This protocol encompasses a pragmatic, observational, multicenter, non-interventional, prospective trial. The study's programmed duration is five years, with a half-yearly analysis of the primary and secondary objectives' measurements. Oncology care health-professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a non-hierarchic fashion. VMTB employ an innovative, virtual, cloud-based platform to share anonymized medical data which are discussed via a videoconferencing system both satisfying security criteria and HIPAA compliance. RESULTS The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region in Italy. Results of this study will particularly focus on the organization of VMTB involving oncology units present in different hospitals spread in the area and create a network to allow best patients care pathways and a hub and spoke relationship. Results will also include data concerning organization skills and pitfalls, barriers, efficiency, number and type con clinical cases, and customers’ satisfaction. CONCLUSIONS VMTB represents a unique opportunity to optimize patient’s management in a patient centered approach. An efficient virtualization and data banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology.

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Clinical Pathways: Development and Implementation

Journal of Integrated Care ◽

10.1177/146245679800200103 ◽

1998 ◽

Vol 2 (1) ◽

pp. 5-7 ◽

Cited By ~ 3

Author(s):

Sue Middleton ◽

Adrian Roberts

Keyword(s):

Clinical Pathways

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Clinical pathways for patients with giant cell arteritis during the COVID-19 pandemic: an international perspective

The Lancet Rheumatology ◽

10.1016/s2665-9913(20)30386-6 ◽

2021 ◽

Vol 3 (1) ◽

pp. e71-e82

Author(s):

Sarah L Mackie ◽

Elisabeth Brouwer ◽

Richard Conway ◽

Kornelis S M van der Geest ◽

Puja Mehta ◽

...

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Clinical Pathways ◽

International Perspective

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Acceptability and effectiveness of antimicrobial stewardship implementation strategies on fluoroquinolone prescribing

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.10 ◽

2021 ◽

pp. 1-8

Author(s):

Katie J. Suda ◽

Gosia S. Clore ◽

Charlesnika T. Evans ◽

Heather Schacht Reisinger ◽

Ibuola Kale ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Clinical Pathways ◽

Statistical Significance ◽

Implementation Strategies ◽

Antibiotic Use ◽

Audit And Feedback ◽

Prior Approval ◽

Days Of Therapy ◽

Prospective Audit And Feedback ◽

Advanced Generation

Abstract Objective: To assess the effectiveness and acceptability of antimicrobial stewardship-focused implementation strategies on inpatient fluoroquinolones. Methods: Stewardship champions at 15 hospitals were surveyed regarding the use and acceptability of strategies to improve fluoroquinolone prescribing. Antibiotic days of therapy (DOT) per 1,000 days present (DP) for sites with and without prospective audit and feedback (PAF) and/or prior approval were compared. Results: Among all of the sites, 60% had PAF or prior approval implemented for fluoroquinolones. Compared to sites using neither strategy (64.2 ± 34.4 DOT/DP), fluoroquinolone prescribing rates were lower for sites that employed PAF and/or prior approval (35.5 ± 9.8; P = .03) and decreased from 2017 to 2018 (P < .001). This decrease occurred without an increase in advanced-generation cephalosporins. Total antibiotic rates were 13% lower for sites with PAF and/or prior approval, but this difference did not reach statistical significance (P = .20). Sites reporting that PAF and/or prior approval were “completely” accepted had lower fluoroquinolone rates than sites where it was “moderately” accepted (34.2 ± 5.7 vs 48.7 ± 4.5; P < .01). Sites reported that clinical pathways and/or local guidelines (93%), prior approval (93%), and order forms (80%) “would” or “may” be effective in improving fluoroquinolone use. Although most sites (73%) indicated that requiring infectious disease consults would or may be effective in improving fluoroquinolones, 87% perceived implementation to be difficult. Conclusions: PAF and prior approval implementation strategies focused on fluoroquinolones were associated with significantly lower fluoroquinolone prescribing rates and nonsignificant decreases in total antibiotic use, suggesting limited evidence for class substitution. The association of acceptability of strategies with lower rates highlights the importance of culture. These results may indicate increased acceptability of implementation strategies and/or sensitivity to FDA warnings.

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Mapping, assessing and promoting multiple psychological senses of community (MPSOC) through clinical pathways for treating substance use problems

Nordic Studies on Alcohol and Drugs ◽

10.1177/1455072520985976 ◽

2021 ◽

pp. 145507252098597

Author(s):

Nina Kavita Heggen Bahl ◽

Anne Signe Landheim ◽

Hilde Eileen Nafstad ◽

Rolv Mikkel Blakar ◽

Morten A. Brodahl

Keyword(s):

Substance Use ◽

Clinical Pathways ◽

Collaborative Study ◽

Social Situation ◽

National Guidelines ◽

Social Situations ◽

Recovery Processes ◽

Substance Use Problems ◽

Problematic Substance Use ◽

Problematic Substance

Aim: The recent nationally implemented clinical pathways for the treatment of substance use problems in Norway require mapping and assessing of patients’ needs, challenges, and resources. However, there is a lack of tools for systematically mapping and assessing patients’ social situations and social networks as part of the national guidelines. The aim of this article is to present a tool developed to map and assess the patient’s social situation, and to propose approaches for promoting multiple psychological senses of community (MPSOC) through clinical pathways for treating substance use problems. Methods: The proposed tool and approaches are developed based on findings in a previous in-depth collaborative study of MPSOC and recovery among people with substance use problems who received help and services from Norwegian municipalities. Findings: The findings suggest that multiple communities (geographical, relational and ideal) and senses of communities (within and outside treatment) simultaneously can influence individual recovery processes from problematic substance use in both positive as well as negative ways. As such, these community dimensions are of central importance to include in mapping and assessing of patients’ social situations, as well as in the promotion of MPSOC through clinical pathways. Conclusions: The suggested tool and approaches can increase the likelihood of achieving key aims of the national clinical pathways. Most important, mapping, assessing and promoting MPSOC through clinical pathways may promote long-term recovery processes and positive recovery capital for persons with substance use problems.

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“What is the actual goal of the pathway?”: examining emergency department physician and nurse perspectives on the implementation of a pediatric concussion pathway using the theoretical domains framework

BMC Health Services Research ◽

10.1186/s12913-021-06110-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anh Ly ◽

Roger Zemek ◽

Bruce Wright ◽

Jennifer Zwicker ◽

Kathryn Schneider ◽

...

Keyword(s):

Emergency Department ◽

Health Care Providers ◽

Clinical Pathways ◽

Theoretical Domains Framework ◽

Local Context ◽

Emergency Department Physician ◽

Evidence Based ◽

Care Providers ◽

Structured Interviews ◽

Pediatric Concussion

Abstract Background Multiple evidence-based clinical practice guidelines (CPGs) exist to guide the management of concussion in children, but few have been translated into clinical pathways (CP), which operationalize guidelines into accessible and actionable algorithms that can be more readily implemented by health care providers. This study aimed to identify the clinical behaviours, attitudinal factors, and environmental contexts that potentially influence the implementation of a clinical pathway for pediatric concussion. Methods Semi-structured interviews were conducted from October 2017 to January 2018 with 42 emergency department clinicians (17 physicians, 25 nurses) at five urban emergency departments in Alberta, Canada. A Theoretical Domains Framework (TDF)-informed interview guide contained open-ended questions intended to gather feedback on the proposed pathway developed for the study, as well as factors that could potentially influence its implementation. Results The original 14 domains of the TDF were collapsed into 6 clusters based on significant overlap between domains in the issues discussed by clinicians: 1) knowledge, skills, and practice; 2) professional roles and identity; 3) attitudes, beliefs, and motivations; 4) goals and priorities; 5) local context and resources; and 6) engagement and collaboration. The 6 clusters identified in the interviews each reflect 2–4 predominant topics that can be condensed into six overarching themes regarding clinicians’ views on the implementation of a concussion CP: 1) standardization in the midst of evolving research; 2) clarifying and communicating goals; 3) knowledge dissemination and alignment of information; 4) a team-oriented approach; 5) site engagement; and 6) streamlining clinical processes. Conclusion Application of a comprehensive, evidence-based, and theory-driven framework in conjunction with an inductive thematic analysis approach enabled six themes to emerge as to how to successfullly implement a concussion CP.

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A Patient-Held Medical Record Integrating Depression Care into Diabetes Care

Japanese Clinical Medicine ◽

10.4137/jcm.s39766 ◽

2016 ◽

Vol 7 ◽

pp. JCM.S39766 ◽

Cited By ~ 1

Author(s):

Noriko Satoh-Asahara ◽

Hiroto Ito ◽

Tomoyuki Akashi ◽

Hajime Yamakage ◽

Kazuhiko Kotani ◽

...

Keyword(s):

Health Care Providers ◽

Diabetes Care ◽

Clinical Pathways ◽

Coping Resources ◽

Care Providers ◽

Depression Care ◽

Patients With Diabetes ◽

And Coping ◽

Levels Of Integration

Purpose Depression is frequently observed in people with diabetes. The purpose of this study is to develop a tool for individuals with diabetes and depression to communicate their comorbid conditions to health-care providers. Method We searched the Internet to review patient-held medical records (PHRs) of patients with diabetes and examine current levels of integration of diabetes and depression care in Japan. Results Eight sets of PHRs were found for people with diabetes. All PHRs included clinical follow-up of diabetes and multidisciplinary clinical pathways for diabetes care. No PHRs included depression monitoring and/or treatment. In terms of an integrated PHR for a patient comorbid with diabetes and depression, necessary components include hopes/preferences, educational information on diabetes complications and treatment, medical history, stress and coping, resources, and monitoring diabetes and depression. Conclusion A new PHR may be suitable for comorbid patients with diabetes and depression.

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