On-Demand Learning Lab: Should I Stay or Should I Go – ED Clinical Pathways Guiding the Way-Recording - Should I Stay or Should I Go

Video Transcription

Video Summary

NACU hosted a Live Learning Lab webinar, “Should I Stay or Should I Go: ED Clinical Pathways Guiding the Way,” presented by Alana Palmquist from BayCare Health System. BayCare described its care transformation strategy to reduce waste, variation, and unnecessary utilization through a governance structure that connects service lines/collaboratives to an integrating Clinical Product Committee. Palmquist outlined BayCare’s pathway methodology: careful scoping and population definition, evidence-based design, EMR build (algorithms, order sets, documentation tools), implementation, and ongoing PDSA updates with dashboard monitoring.<br /><br />The session focused on three emergency department pathways aimed at safely discharging low-risk patients while ensuring rapid follow-up: low-risk chest pain (HEART score with shared decision-making documentation and streamlined cardiology/primary care scheduling via QR code/phone/web), low-risk DVT (outpatient criteria plus access to Xarelto starter packs), and a newer ED atrial fibrillation pathway (rate/rhythm control, required risk scores, anticoagulation support, and expedited cardiology follow-up). Results included increased HEART score documentation, more discharges without higher revisits, and nearly 1,000 DVT patients discharged over three years.<br /><br />Palmquist also highlighted ED’s “gatekeeper” role in inpatient pathways (heart failure, hip fracture, sepsis, stroke), showing improvements in diuretic timing, complications, mortality trends, and door-to-needle performance. Key success factors were strategic alignment, leadership support, project management, provider engagement, and transparent metrics, while challenges included slow timelines, staffing, and documentation.

Keywords

NACU Live Learning Lab webinar

BayCare Health System

emergency department clinical pathways

care transformation strategy

HEART score low-risk chest pain

low-risk DVT outpatient discharge

ED atrial fibrillation pathway

EMR build order sets algorithms

PDSA dashboard monitoring