TY  - JOUR
PY  - 2023//
TI  - Health care impact of implementing a clinical pathway for acute care of pediatric concussion: a stepped wedge, cluster randomised trial
JO  - Canadian journal of emergency medicine
A1  - Yeates, Keith Owen
A1  - Barlow, Karen M.
A1  - Wright, Bruce
A1  - Tang, Ken
A1  - Barrett, Olesya
A1  - Berdusco, Edward
A1  - Black, Amanda M.
A1  - Clark, Brenda
A1  - Conradi, Alf
A1  - Godfrey, Heather
A1  - Kolstad, Ashley T.
A1  - Ly, Anh
A1  - Mikrogianakis, Angelo
A1  - Purser, Ross
A1  - Schneider, Kathryn
A1  - Stang, Antonia S.
A1  - Zemek, Roger
A1  - Zwicker, Jennifer D.
A1  - Johnson, David W.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - OBJECTIVES: To test the effects of actively implementing a clinical pathway for acute care of pediatric concussion on health care utilization and costs. <br><br>METHODS: Stepped wedge, cluster randomized trial of a clinical pathway, conducted in 5 emergency departments (ED) in Alberta, Canada from February 1 to November 30, 2019. The clinical pathway emphasized standardized assessment of risk for persistent symptoms, provision of consistent information to patients and families, and referral for outpatient follow-up. De-identified administrative data measured 6 outcomes: ED return visits; outpatient follow-up visits; length of ED stay, including total time, time from triage to physician initial assessment, and time from physician initial assessment to disposition; and total physician claims in an episode of care. <br><br>RESULTS: A total of 2878 unique patients (1164 female, 1713 male) aged 5-17 years (median 11.00, IQR 8, 14) met case criteria. They completed 3009 visits to the 5 sites and 781 follow-up visits to outpatient care, constituting 2910 episodes of care. Implementation did not alter the likelihood of an ED return visit (OR 0.77, 95% CI 0.39, 1.52), but increased the likelihood of outpatient follow-up visits (OR 1.84, 95% CI 1.19, 2.85). Total length of ED stay was unchanged, but time from physician initial assessment to disposition decreased significantly (mean change - 23.76 min, 95% CI - 37.99, - 9.52). Total physician claims increased significantly at only 1 of 5 sites. <br><br>CONCLUSIONS: Implementation of a clinical pathway in the ED increased outpatient follow-up and reduced the time from physician initial assessment to disposition, without increasing physician costs. Implementation of a clinical pathway can align acute care of pediatric concussion more closely with existing clinical practice guidelines while making care more efficient. TRIAL REGISTRATION: ClinicalTrials.gov NCT05095012.<p />  <p>Language: en</p>
LA  - en
SN  - 1481-8035
UR  - http://dx.doi.org/10.1007/s43678-023-00530-1
ID  - ref1
ER  -