Background: The COVID-19 pandemic has required healthcare systems to meet new demands for rapid information dissemination, resource allocation, and patient tracking and reporting. To help address these unique challenges, the University of Chicago Medical Center (UCMC) has leveraged Integrated Clinical Pathways (ICPs), which are flexible decision support tools integrated directly into the electronic health record. The objective of this study is to describe the institution’s creation and use of ICPs to address the COVID-19 pandemic, and to assess the adoption and impact of these pathways.
Methods: Using the ICP infrastructure already established at UCMC as a foundation, we assembled a team specific to the COVID-19 efforts and modified existing procedures to accommodate the needs of the pandemic. We developed a suite of COVID-19 specific pathways using the AgileMD platform, which facilitated implementation of rapidly changes best practices and provided functionality to enable direct ordering of tests and treatments from the ICP interface. Outcomes were evaluated using descriptive analyses of ICP use during the study period of March 1 to September 1, 2020.
Results: During the study period, 28 COVID-19 specific pathways were developed, 21 of which were created within the first 2 weeks, pertaining to triage, diagnosis, and management of COVID-19 across different specialties (e.g. internal medicine, pediatrics and obstetrics) and different settings (e.g. emergency department, critical care). Information included in ICPs included links for testing and treatment orders, isolation precautions, and admission and transfer order sets (Figure 1). Pathways were accessed 8,931 times, with 73,346 individual orders placed and 1,171 order sets used (Figure 2). Triage and reporting capabilities were supported through the use of pathway enrollment features.
Conclusions: ICPs provide an agile and unified mechanism to meet the demands set forth by the COVID-19 pandemic and will continue to be a fundamental tool to inform and define the institution’s best practices for the clinical care of patients with COVID-19 and beyond.