Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals

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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Education of Healthcare Professionals on an Integrated Care Pathway in order to Standardize Practice and Improve Outcomes for Individuals with Intellectual and Developmental Disability (IDD) who engage in Self-Injurious Behavior (SIB)

American Journal of Psychiatric Research and Reviews ◽

10.28933/ajprr-2020-10-1505 ◽

2020 ◽

pp. 24

Author(s):

Keyword(s):

Best Practices ◽

Developmental Disability ◽

Health Care Professionals ◽

Care Pathway ◽

Clinical Care ◽

Treatment Team ◽

Intellectual And Developmental Disability ◽

Integrated Care Pathway ◽

Clinical Variation ◽

Clinical Care Pathway

This paper addresses the lack of knowledge and lack of standardization for treating individuals who engage in self-injurious behavior (SIB) to the head. An evidence-based integrated clinical care pathway is described that was created for health care professionals treating individuals with intellectual and developmental disability (IDD) who engage in frequent and/or significant SIB. It is anticipated that this pathway will increase treatment team knowledge of best practices, decrease clinical variation, standardize care, and improve clinical outcomes with this vulnerable population.

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Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center

Otolaryngology ◽

10.1177/0194599816657045 ◽

2016 ◽

Vol 155 (5) ◽

pp. 879-885 ◽

Cited By ~ 11

Author(s):

Peter S. Vosler ◽

Jason I. Kass ◽

Eric W. Wang ◽

Carl H. Snyderman

Keyword(s):

Care Pathway ◽

Clinical Care ◽

Care Center ◽

Tertiary Care ◽

Successful Implementation ◽

Tertiary Care Center ◽

Clinical Care Pathway

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Schwere Epistaxis stoppen – Klinischer Behandlungspfad zahlt sich aus

Gesundheitsökonomie & Qualitätsmanagement ◽

10.1055/s-0043-117328 ◽

2017 ◽

Vol 22 (04) ◽

pp. 178-179

Author(s):

Maria Weiß

Keyword(s):

Head And Neck ◽

Care Pathway ◽

Clinical Care ◽

Care Center ◽

Tertiary Care ◽

Neck Surgery ◽

Successful Implementation ◽

Tertiary Care Center ◽

Klinischer Behandlungspfad ◽

Clinical Care Pathway

Vosler PE et al. Successful Implementation of a Clinical Care Pathway for Management of Epistaxis at a Tertiary Care Center. Otolaryngology – Head and Neck Surgery 2016; 155: 879–885 Die meisten Fälle von Nasenbluten lassen sich leicht in den Griff bekommen – schwere Blutungen aus der Arteria sphenopalatina (SPA) oder unter Antikoagulation können aber eine Herausforderung darstellen. US-amerikanische HNO-Ärzte haben jetzt einen klinischen Behandlungspfad zum Management der schweren Epistaxis entwickelt, den sie in einem Tertiär-Krankenhaus evaluierten.

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Fifth metatarsal fractures in skeletally immature patients do not need routine orthopedic surgeon assessment and follow-up

Paediatrics & Child Health ◽

10.1093/pch/pxaa124 ◽

2020 ◽

Author(s):

Danielle Meschino ◽

John Adamich ◽

Eliane Rioux Trottier ◽

Mark Camp

Keyword(s):

Radiation Exposure ◽

Care Pathway ◽

Clinical Care ◽

Tertiary Care ◽

Radiology Department ◽

X Rays ◽

Skeletally Immature ◽

Paediatric Hospital ◽

Metatarsal Fractures

Abstract Objectives The aim of this study was to determine the rate of delayed or nonunion of fifth metatarsal fractures in skeletally immature patients. Using this information, we sought to develop an evidence-based clinical care pathway in order to mitigate unnecessary patient radiation exposure, costs to families, and costs to the health system. Methods We retrospectively reviewed the charts and radiographs of patients who presented to an academic tertiary-care paediatric hospital between 2009 and 2014 with isolated fifth metatarsal fractures. Results A total of 114 patients (61 males and 53 females) with mean age of 11.2 (SD 3.0) years old were included in the study. No patients required operative management. There was one case of delayed union and no cases of nonunion. There was no association of these complications with fracture type, location, or mechanism of injury. There was no association of complications with immobilization type or immobilization period. Despite the low complication rate and need for surgery, fracture clinic resource utilization was significant. Fractures were managed with a mean number of 3.1 (SD 0.89) clinic visits and a mean number of 2.7 (SD1.0) radiology department visits where a mean total of 7.9 (SD 3.4) x-rays were performed. Conclusions Based on our retrospective review, skeletally immature patients presenting with isolated fifth metatarsal fractures have a very low rate of delayed or nonunion. A selective follow-up strategy will decrease radiation exposure, reduce costs to families and the healthcare system, without compromising clinical outcomes.

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Development of a Clinical Care Pathway for Severe Epistaxis at a Tertiary-Care Medical Center

Otolaryngology ◽

10.1177/0194599814541627a33 ◽

2014 ◽

Vol 151 (1_suppl) ◽

pp. P38-P39

Author(s):

Jason I. Kass ◽

Peter S. Vosler ◽

Eric W. Wang ◽

Carl H. Snyderman

Keyword(s):

Care Pathway ◽

Medical Center ◽

Clinical Care ◽

Tertiary Care ◽

Tertiary Care Medical Center ◽

Severe Epistaxis ◽

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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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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Increase in recruitment upon integration of trial into a clinical care pathway: an observational study

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2021-000967 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000967

Author(s):

Kay Por Yip ◽

Simon Gompertz ◽

Catherine Snelson ◽

Jeremy Willson ◽

Shyam Madathil ◽

...

Keyword(s):

Clinical Trial ◽

Hospital Admissions ◽

Care Pathway ◽

Clinical Care ◽

Intensive Therapy ◽

Respiratory Support ◽

Trial Recruitment ◽

Recruitment Process ◽

Support Unit ◽

Clinical Care Pathway

IntroductionMany respiratory clinical trials fail to reach their recruitment target and this problem exacerbates existing funding issues. Integration of the clinical trial recruitment process into a clinical care pathway (CCP) may represent an effective way to significantly increase recruitment numbers.MethodsA respiratory support unit and a CCP for escalation of patients with severe COVID-19 were established on 11 January 2021. The recruitment process for the Randomised Evaluation of COVID-19 Therapy-Respiratory Support trial was integrated into the CCP on the same date. Recruitment data for the trial were collected before and after integration into the CCP.ResultsOn integration of the recruitment process into a CCP, there was a significant increase in recruitment numbers. Fifty patients were recruited over 266 days before this process occurred whereas 108 patients were recruited over 49 days after this process. There was a statistically significant increase in both the proportion of recruited patients relative to the number of COVID-19 hospital admissions (change from 2.8% to 9.1%, p<0.0001) and intensive therapy unit admissions (change from 17.8% to 50.2%, p<0.001) over the same period, showing that this increase in recruitment was independent of COVID-19 prevalence.DiscussionIntegrating the trial recruitment process into a CCP can significantly boost recruitment numbers. This represents an innovative model that can be used to maximise recruitment without impacting on the financial and labour costs associated with the running of a respiratory clinical trial.

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Abstract 6101: Cost Effectiveness of Cardiac Computed Tomography Compared to Myocardial Perfusion Imaging (MPI) as an Effective Gatekeeper to Cardiac Catheterization in the Evaluation of Asymptomatic Firefighters with an Abnormal Treadmill Test

Circulation ◽

10.1161/circ.118.suppl_18.s_1061-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Matthew Budoff ◽

Robert Karwasky ◽

Naser Ahmadi MD Ahmadi ◽

Cyrus A Nasserian ◽

William W Chang ◽

...

Keyword(s):

Los Angeles ◽

Care Pathway ◽

Cardiac Computed Tomography ◽

Clinical Care ◽

Invasive Coronary Angiography ◽

Calcium Score ◽

Computed Tomographic Angiography ◽

Sensitivity Analyses ◽

Computed Tomographic ◽

Clinical Care Pathway

To identify CAD among patients who fail treadmill tests, the traditional clinical care pathway is MPI, then invasive coronary angiography (ICA). In a retrospective cohort study, we compared the direct costs for detecting CAD using the traditional clinical care pathway and an alternative that incorporates MDCT, with coronary calcium score (CCS) followed by computed tomographic angiography (CTA) and ICA. Over a 2-year period, 3,950 Los Angeles, CA Firefighters underwent wellness/fitness exams at 6 contracted medical facilities. A total of 495 cases had abnormal treadmill tests and were referred for follow-up cardiology evaluation. All cases received CCS, followed by CTA for calcium scores >10, and ICA for abnormal CTA (>50% obstruction in at least one vessel). MPI results were estimated based on the prior year’s experience, with abnormal MPI receiving ICA. Costs to detect CAD were calculated for both the MPI and MDCT pathways based on results for the cohort and current Medicare reimbursement costs. Sensitivity analyses were performed by varying each of the clinical and cost components of the model to “low” and “high” levels and computing net costs. Most model inputs were varied by ±50% of baseline values to gauge the robustness of the results. Among 495 cases with abnormal treadmill tests, 146 (29.5%) would have required ICA due to abnormal MPI tests; 131 (26.9%) had abnormal CCS (>10) and went to CTA; 40 (8.1%) had abnormal CTA (>50% stenosis) and went to ICA. ICA showed 38 (7.7%) cases of CAD. The computed cost to detect CAD was $1,376 per case for the traditional route with MPI as gatekeeper and $503 per case for CCS as gatekeeper. All sensitivity analyses showed lower costs for the MDCT compared to MPI pathways. The net cost to ICA-confirmed diagnosis of CAD is substantially lower with MDCT compared to MPI as gatekeeper to ICA.

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