On-Demand Learning Lab: Should I Stay or Should I Go – ED Clinical Pathways Guiding the Way-Slide Deck August 2023 Learning Lab

Slide Deck August 2023 Learning Lab

Pdf Summary

This document outlines BayCare Health System’s approach to designing, implementing, and sustaining clinical pathways—especially in the Emergency Department (ED)—as part of a broader “Care Transformation” strategy aimed at reducing waste, improving outcomes, and supporting value-based care. BayCare is a large not-for-profit system in West Central Florida with 16 acute care hospitals and an extensive continuum of community-based, acute, and post-acute services.

The presentation defines clinical pathways as structured, multidisciplinary, evidence-based care plans that standardize essential steps for specific conditions to optimize outcomes and efficiency. BayCare uses a Plan-Do-Study-Act methodology and a governance structure to prioritize, implement, evaluate, and refine pathways. The system has multiple completed pathways (including ED Low Risk Chest Pain, ED Low Risk DVT, and ED Atrial Fibrillation) and a goal of 20 total pathways by 2024 to cover about 60% of the patient population.

Key ED pathways described include:
- <strong>Low Risk Chest Pain (suspected ACS):</strong> Built around the HEART score with EMR-integrated scoring, order sets, tracker-board alerts, tailored patient education, and streamlined cardiology follow-up (including QR codes and agreed appointment timeframes). Implemented during the pandemic (8/24/21).
- <strong>Low Risk DVT:</strong> Identifies patients safe for discharge on anticoagulation with follow-up in 7–14 days, supported by pharmacy access to starter packs and dashboards tracking discharges and revisits; showed increased appropriate outpatient DOAC use.
- <strong>Atrial Fibrillation:</strong> Emphasizes stabilization and possible ED discharge using algorithms, order sets, CHADS2/VASc and HAS-BLED documentation, discharge instructions, and rapid cardiology follow-up.

The ED is also positioned as the “gatekeeper” for inpatient pathways (heart failure, hip fracture, sepsis, stroke) through early decisions, initial treatment, order set use, and communication. Reported results include improved diuretic timing and mortality in heart failure, faster time-to-OR and fewer complications in hip fracture, reduced sepsis mortality, and improved stroke door-to-needle performance.

Success factors include leadership support, aligned strategy, engaged ED medical leadership, continuous improvement culture, and transparent metrics; lessons learned emphasize the need for dedicated project management, clear population definitions, baseline data, and sufficient resources.

Keywords

BayCare Health System

clinical pathways

Emergency Department

care transformation

value-based care

Plan-Do-Study-Act (PDSA)

HEART score low-risk chest pain

low-risk DVT outpatient anticoagulation (DOAC)

atrial fibrillation ED discharge protocol

EMR-integrated order sets and dashboards