Grant: Operating Grant

A clinical pathway (CP) is a tool used by healthcare teams to organize and document care for specific medical conditions. Based on the best available research, and organized into specific treatment recommendations to be tailored for each patient, CPs have many potential benefits such as improved patient care and safety, decreased healthcare costs and efficiency through standardized care plans anticipated by the entire health team. While most hospitals create their own CPs with local experts, high-quality CPs are created by teams of clinical and research experts from all relevant health professions. Local implementation of expert-developed CPs can be a challenge and effective implementation approaches are unknown. In this three year study, we will design and evaluate best strategies for effective implementation of two expert-developed CPs. This study will use provincial CPs related to pediatric emergency care: a Pediatric Asthma CP and a Pediatric Vomiting & Diarrhea CP (developed in Ontario and Alberta, respectively). Both are high quality CPs designed for use in any emergency department (ED) and have not been implemented in Ontario. In addition to adaptations at the hospital system level, full implementation requires a number of behaviour changes among health professionals. We will use an established theory framework to develop an organized, complete approach to promote the changes required for implementation in 16 community EDs. Once the CP has been prepared for use in each hospital and the health professionals have been taught how to use it, we will review patient outcomes to observe important differences and evaluate the costs to achieve any benefits gained. We will use a process log to track progress and learn from the experience with each hospital. This work will enhance our understanding of key requirements for practical, feasible, effective implementation of CPs at the local level, and may lead to better use of research findings in clinical practice.