Does the implementation of a clinical care pathway have an impact on early intravenous fluid therapy of acute pancreatitis? a pilot quality improvement study

Background. Patients with nonepileptic seizures (NES) are challenging to treat for myriad reasons. Often patients may be misdiagnosed with having epilepsy and then may suffer unintended consequences of treatment side effects with antiepileptic medication. In addition, patients may be maligned by health care providers due to a lack of ownership by both psychiatrists and neurologists and a dearth of dedicated professionals who are able to effectively treat and reduce severity and frequency of symptoms.Aims of Case Report. Many psychiatrists and neurologists are unaware of the extent of the barriers to care faced by patients with NES (PWNES) and the degree of perception of maltreatment or lack of therapeutic alliance at various stages of their care, including medical workup, video-EEG monitoring, and follow-up plans. We present the case of a patient with NES who experienced numerous barriers as well as incoordination to her care despite being offered a breadth of resources and discuss the quality improvement opportunities that may exist to improve care of patients with NES.Conclusion. No known literature has documented the extensive barriers to care of PWNES in parallel to quality improvement opportunities for improving their care. We endeavor to contribute to the overall formulation and development of a clinical care pathway for PWNES.

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Nonaggressive Versus Aggressive Intravenous Fluid Therapy in Acute Pancreatitis With More Than 24 Hours From Disease Onset

Pancreas ◽

10.1097/mpa.0000000000001528 ◽

2020 ◽

Vol 49 (4) ◽

pp. 579-583 ◽

Cited By ~ 1

Author(s):

Jesús Eduardo Cuéllar-Monterrubio ◽

Roberto Monreal-Robles ◽

Emmanuel I. González-Moreno ◽

Omar D. Borjas-Almaguer ◽

José Luis Herrera-Elizondo ◽

...

Keyword(s):

Acute Pancreatitis ◽

Fluid Therapy ◽

Disease Onset ◽

Intravenous Fluid ◽

Intravenous Fluid Therapy

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Intravenous fluid therapy in acute pancreatitis: a critical review of the randomized trials

ANZ Journal of Surgery ◽

10.1111/ans.14320 ◽

2017 ◽

Vol 88 (7-8) ◽

pp. 690-696

Author(s):

Andrew Thomson

Keyword(s):

Acute Pancreatitis ◽

Fluid Therapy ◽

Critical Review ◽

Randomized Trials ◽

Intravenous Fluid ◽

Intravenous Fluid Therapy

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Developing a clinical care pathway for obese pregnant women: A quality improvement project

Women and Birth ◽

10.1016/j.wombi.2014.09.001 ◽

2014 ◽

Vol 27 (4) ◽

pp. e67-e71 ◽

Cited By ~ 5

Author(s):

Shanna Fealy ◽

Alexis Hure ◽

Graeme Browne ◽

Carol Prince

Keyword(s):

Quality Improvement ◽

Pregnant Women ◽

Care Pathway ◽

Clinical Care ◽

Quality Improvement Project ◽

Improvement Project ◽

Clinical Care Pathway

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Retrospective Review and Proof of Concept of Asia’s First Mobile Stroke Unit Experience in Kovai Medical Center and Hospital

Journal of Stroke Medicine ◽

10.1177/2516608520968418 ◽

2020 ◽

Vol 3 (2) ◽

pp. 116-123

Author(s):

Mathew Cherian ◽

Pankaj Mehta ◽

Shriram Varadharajan ◽

Santosh Poyyamozhi ◽

Elango Swamiappan ◽

...

Keyword(s):

Acute Stroke ◽

Retrospective Review ◽

Stroke Unit ◽

Care Pathway ◽

Clinical Care ◽

Stroke Care ◽

First Year ◽

Proof Of Concept ◽

Mobile Stroke Unit ◽

Clinical Care Pathway

Background: We review our initial experience of India’s and Asia’s first mobile stroke unit (MSU) following the completion of its first year of operation. We outline the clinical care pathway integrating the MSU services using a case example taking readers along our clinical care workflow while highlighting the challenges faced in organizing and optimizing such services in India. Methods: Retrospective review of data collected for all patients from March 2018 to February 2019 transported and treated within the MSU during the first year of its operation. Recent case example is reviewed highlighting complete comprehensive acute clinical care pathway from prehospital MSU services to advanced endovascular treatment with focus on challenges faced in developing nation for stroke care. Results: The MSU was dispatched and utilized for 14 patients with clinical symptoms of acute stroke. These patients were predominantly males (64%) with median age of 59 years. Ischemic stroke was seen in 7 patients, hemorrhagic in 6, and 1 patient was classified as stroke mimic. Intravenous tissue plasminogen activator was administered to 3 patients within MSU. Most of the patients’ treatment was initiated within 2 h of symptom onset and with the median time of patient contact (rendezvous) following stroke being 55 mins. Conclusion: Retrospective review of Asia’s first MSU reveals its proof of concept in India. Although the number of patients availing treatment in MSU is low as compared to elsewhere in the world, increased public awareness with active government support including subsidizing treatment costs could accelerate development of optimal prehospital acute stroke care policy in India.

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Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

Nutrients ◽

10.3390/nu13082635 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2635

Author(s):

Koen Huysentruyt ◽

Kim Brunet-Wood ◽

Robert Bandsma ◽

Leah Gramlich ◽

Bonnie Fleming-Carroll ◽

...

Keyword(s):

Health Care Professionals ◽

Care Pathway ◽

Clinical Care ◽

Tertiary Care ◽

Nationwide Survey ◽

Nutritional Screening ◽

Pediatric Hospitals ◽

Adoption And Implementation ◽

Clinical Care Pathway

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or “a work in progress”, according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

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Nurses’ knowledge regarding intravenous fluid therapy at a County hospital in Kenya

International Journal of Africa Nursing Sciences ◽

10.1016/j.ijans.2021.100305 ◽

2021 ◽

pp. 100305

Author(s):

Njung'e Winfridah Wangui ◽

Kamolo Elizabeth Kalondu

Keyword(s):

Fluid Therapy ◽

Intravenous Fluid ◽

County Hospital ◽

Intravenous Fluid Therapy ◽

Nurses Knowledge

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Optimizing Outcomes After Cleft Palate Repair: Design and Implementation of a Perioperative Clinical Care Pathway

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211017409 ◽

2021 ◽

pp. 105566562110174

Author(s):

Thomas R. Cawthorn ◽

Anna R. Todd ◽

Nina Hardcastle ◽

Adam O. Spencer ◽

A. Robertson Harrop ◽

...

Keyword(s):

Length Of Stay ◽

Cleft Palate ◽

Care Pathway ◽

Clinical Care ◽

Oral Intake ◽

Opioid Consumption ◽

Complication Rates ◽

Cleft Palate Repair ◽

Palate Repair ◽

Clinical Care Pathway

Objective: To evaluate the development process and clinical impact of implementing a standardized perioperative clinical care pathway for cleft palate repair. Design: Medical records of patients undergoing primary cleft palate repair prior to pathway implementation were retrospectively reviewed as a historical control group (N = 40). The historical cohort was compared to a prospectively collected group of patients who were treated according to the pathway (N = 40). Patients: Healthy, nonsyndromic infants undergoing primary cleft palate repair at a tertiary care pediatric hospital. Interventions: A novel, standardized pathway was created through an iterative process, combining literature review with expert opinion and discussions with institutional stakeholders. The pathway integrated multimodal analgesia throughout the perioperative course and included intraoperative bilateral maxillary nerve blocks. Perioperative protocols for preoperative fasting, case timing, antiemetics, intravenous fluid management, and postoperative diet advancement were standardized. Main Outcome Measures: Primary outcomes include: (1) length of hospital stay, (2) cumulative opioid consumption, (3) oral intake postoperatively. Results: Patients treated according to the pathway had shorter mean length of stay (31 vs 57 hours, P < .001), decreased cumulative morphine consumption (77 vs 727 μg/kg, P < .001), shorter time to initiate oral intake (9.3 vs 22 hours, P = .01), and greater volume of oral intake in first 24 hours postoperatively (379 vs 171 mL, P < .001). There were no differences in total anesthesia time, total surgical time, or complication rates between the control and treatment groups. Conclusions: Implementation of a standardized perioperative clinical care pathway for primary cleft palate repair is safe, feasible, and associated with reduced length of stay, reduced opioid consumption, and improved oral intake postoperatively.

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