Síguenos en Twitter     Síguenos en Facebook     Síguenos en YouTube     Siguenos en Linkedin     Correo Salutsantjoan     Gmail     Dropbox     Instagram     Google Drive     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon     StumbleUpon


My photo
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, July 15, 2016

Clinical Pathway Use

emDocs - July  14, 2016 - Authors: Long B and Sheridan B
Edited by: Koyfman A  & Bright J
Clinical decision rules (CDR) can improve decision-making in specific situations in the ED, potentially decreasing further testing and improving disposition times. This part of the CDR series will look in detail at a current clinically significant CDR and pathway – The HEART pathway.
Part 1 of this series listed the essentials a CDR should possess: answers a relevant question, addresses a common clinical problem, appropriately derived, externally validated, improves clinical practice, applicable to practice and patients, and ease of use. http://www.emdocs.net/clinical-decision-rules-part-1/
Part 2 examined applying a CDR to actual clinical practice, which involved several steps: determining the rule that would most affect patient care in your setting, identify obstacles to implementation (provider and institution), achieving buy-in (from all members of the team including nurses and other specialties/consultants), publicizing pathway use, and monitoring and refinement of the rule once in place. http://www.emdocs.net/clinical-decision-rules-part-2/
Part 3 will evaluate actual risk of missed MI in chest pain patients, followed by a look at several clinical rules and pathways.
  • Risk stratification in patients with low risk chest pain has significantly evolved over the past decade. Multiple tools have been derived and evaluated for patient disposition decisions.
  • TIMI and GRACE are not sensitive enough to use in the undifferentiated patient in the ED with chest pain.
  • Decision pathways using these scores should be used with caution, though patients with two negative biomarkers and negative ECG for ischemia are at low risk for MACE.
  • The HEART score and pathway provide the best sensitivity and NPV capability, while classifying a large percentage of patients as low risk.
  • By combining the use of this rule with shared decision making, this pathway provides safe, efficient care, protecting the patient and physician.