{"id":1232,"date":"2021-06-01T18:49:16","date_gmt":"2021-06-01T18:49:16","guid":{"rendered":"https:\/\/www.hospitalinnovate.org\/covid19\/?page_id=1232"},"modified":"2022-04-04T20:33:34","modified_gmt":"2022-04-04T20:33:34","slug":"clinical-pathways-overview","status":"publish","type":"page","link":"https:\/\/www.hospitalinnovate.org\/covid19\/clinical-pathways-and-documentation\/clinical-pathways-overview\/","title":{"rendered":"Clinical Pathways Overview"},"content":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; equal_height=&#8221;yes&#8221; content_placement=&#8221;bottom&#8221; css=&#8221;.vc_custom_1601408973850{margin-top: 0px !important;margin-bottom: 0px !important;border-bottom-width: 4px !important;padding-top: 0px !important;padding-right: 20px !important;padding-bottom: 0px !important;padding-left: 20px !important;background-color: #f2f2f2 !important;border-bottom-color: #2c5d73 !important;border-bottom-style: solid !important;}&#8221;][vc_column width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1599239336771{padding-right: 20px !important;padding-left: 10px !important;}&#8221;][cesis_icon_paragraph i_size=&#8221;20&#8243; heading=&#8221;Clinical Pathways &#8211; OVERVIEW&#8221; text=&#8221;&#8221; margin_top=&#8221;40&#8243; icon_color=&#8221;#f7941d&#8221; h_icon_color=&#8221;#f7941d&#8221; heading_color=&#8221;#f7941d&#8221; heading_h_color=&#8221;#f7941d&#8221; heading_f_size=&#8221;20px&#8221; heading_f_weight=&#8221;600&#8243; heading_l_height=&#8221;30px&#8221; heading_t_transform=&#8221;none&#8221; icon=&#8221;fa-page&#8221;][\/cesis_icon_paragraph][\/vc_column][vc_column width=&#8221;1\/2&#8243;][cesis_breadcrumb pos=&#8221;cesis_breadcrumb_right&#8221; force_font=&#8221;custom&#8221; bread_color=&#8221;#2c5d73&#8243; bread_hover_color=&#8221;#2c5d73&#8243; f_size=&#8221;10px&#8221; f_weight=&#8221;300&#8243; t_transform=&#8221;uppercase&#8221; margin_bottom=&#8221;20&#8243;][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; gap=&#8221;20&#8243; equal_height=&#8221;yes&#8221; css=&#8221;.vc_custom_1601409020186{margin-top: 0px !important;padding-top: 0px !important;padding-right: 20px !important;}&#8221;][vc_column width=&#8221;1\/4&#8243; css=&#8221;.vc_custom_1622657785664{margin-top: 0px !important;margin-right: px !important;margin-bottom: px !important;margin-left: px !important;border-left-width: 0px !important;padding-top: 20px !important;padding-right: 8px !important;padding-bottom: 8px !important;padding-left: 8px !important;background-color: #f5f5f5 !important;border-left-color: #f5f5f5 !important;border-left-style: solid !important;}&#8221;][cesis_icon i_size=&#8221;20&#8243; position=&#8221;i_float_left&#8221; margin_right=&#8221;10&#8243; icon_color=&#8221;#f7941d&#8221; icon=&#8221;fa-page&#8221;][vc_column_text font_size=&#8221;16px&#8221; text_resize=&#8221;yes&#8221; text_minimum=&#8221;10&#8243; line_height=&#8221;1.25em&#8221; css=&#8221;.vc_custom_1616613241528{margin-top: 0px !important;margin-right: 0px !important;margin-bottom: 0px !important;margin-left: 0px !important;}&#8221; font_color=&#8221;#2c5d73&#8243;]<strong>Clinical Pathways and Documentation<\/strong>[\/vc_column_text][vc_wp_custommenu nav_menu=&#8221;24&#8243;][cesis_line_divider width=&#8221;&#8221;][vc_column_text]<em>Last Updated: Jun. 1, 2021<\/em>[\/vc_column_text][\/vc_column][vc_column width=&#8221;3\/4&#8243; css=&#8221;.vc_custom_1622657802360{margin-top: 20px !important;padding-top: 8px !important;padding-right: 8px !important;padding-bottom: 8px !important;padding-left: 8px !important;border-radius: 4px !important;}&#8221;][vc_row_inner gap=&#8221;20&#8243; css=&#8221;.vc_custom_1600126612328{padding-left: 10px !important;}&#8221;][vc_column_inner width=&#8221;1\/2&#8243;][vc_column_text]<\/p>\n<h3><strong>Team Leads<\/strong><\/h3>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Amy Berger, MD, PhD (University of California, San Francisco School of Medicine)<\/li>\n<li>Alan A. Kubey, MD, (Thomas Jefferson University Hospital and Mayo Clinic)<\/li>\n<li>Andrew Auerbach, MD, MPH (University of California, San Francisco School of Medicine)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h3><strong>Authors<\/strong><\/h3>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Sneha Daya, MD (University of California, San Francisco School of Medicine)<\/li>\n<li>Kristen Kipps, MD (University of California, San Francisco School of Medicine)<\/li>\n<li>Rashmi Manjunath, MD (University of California, San Francisco School of Medicine)<\/li>\n<li>Katie E. Raffel, MD (Denver Health, University of Colorado School of Medicine)<\/li>\n<li>Noa Simchoni, MD, PhD (University of California, San Francisco School of Medicine)<\/li>\n<li>Zhenya Krapivinsky, MD (University of California, San Francisco School of Medicine)<\/li>\n<li>Nick Kattan, MD (University of Florida College of Medicine)<\/li>\n<li>Kirsten Nieto, MD (University of Texas Austin, Dell Medical School)<\/li>\n<li>W. Michael Brode, MD (University of Texas at Austin Dell Medical School)<\/li>\n<li>Ethan Kuperman, MD, MSc (University of Iowa Carver College of Medicine)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>[\/vc_column_text][vc_column_text]<\/p>\n<h3>Clinical Pathways and Documentation Publication<\/h3>\n<p>Chang Berger A, Simchoni N, Auerbach A, et al. <a href=\"http:\/\/dx.doi.org\/10.1001\/jamanetworkopen.2022.5657\">Implementation of Clinical Practice Guidelines for Hospitalized Patients With COVID-19 in Academic Medical Centers<\/a>. <em>JAMA Netw Open<\/em>. 2022; 5(4):e225657.[\/vc_column_text][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243;][vc_column_text]<\/p>\n<h3>Topic Area<\/h3>\n<p>Hospitalists trying to provide the best care to patients with COVID-19 have faced tremendous uncertainty, a flood of variable quality, and sometimes contradictory evidence. Although some professional groups have issued guidelines, these guidelines have themselves been based on smaller bodies of lower quality evidence than typically expected, reducing their generalizability and leaving substantial room for clinical judgment. On top of this, surging patient volumes and strained resources have created their own set of challenges; for example, local limitations in access to testing, supplies of key medications, and hospital capacity may have caused health care providers to deviate from recommended care. Finally, many important aspects of clinical care are not included in guidelines and are governed instead by institutional policies and norms.<\/p>\n<p>We conducted a survey to provide a snapshot of COVID-19-related clinical practices across a wide range of domains. The survey period was December 17, 2020, to February 8, 2021. We received responses from 52 of 83 (62%) invitees. Our data skews heavily toward academic medical centers (AMCs), with 94% of respondents describing their hospital as an AMC and only a small fraction as a community (14%) or safety net (14%) hospital. Average hospital medicine census ranged from 26-50 to &gt;300 with a median of 151-200. Peak COVID-19 census also ranged from 26-50 to &gt;300, with a median of 101-150, and 71% of hospitals reported total hospital medicine censuses somewhat or far greater than usual at the peak of their COVID-19 surge.[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner gap=&#8221;20&#8243; css=&#8221;.vc_custom_1622573904535{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;padding-left: 10px !important;}&#8221;][vc_column_inner css=&#8221;.vc_custom_1622573912818{margin-top: 0px !important;margin-bottom: 0px !important;padding-top: 0px !important;padding-bottom: 0px !important;}&#8221;][vc_column_text]<\/p>\n<h3>Professional Guidelines<\/h3>\n<p>The National Institutes of Health (NIH) has released <a href=\"https:\/\/www.covid19treatmentguidelines.nih.gov\/therapeutic-management\/\" target=\"_blank\" rel=\"noopener noreferrer\">clinical practice guidelines<\/a> for the management of COVID-19.<sup><a href=\"#notes\">1<\/a><\/sup> In addition, multiple national professional societies have issued recommendations for specific aspects of COVID-19 care; for example, the Infectious Diseases Society of America (IDSA) regarding <a href=\"https:\/\/www.idsociety.org\/practice-guideline\/covid-19-guideline-treatment-and-management\/\" target=\"_blank\" rel=\"noopener noreferrer\">infection prevention, diagnosis, and therapeutics<\/a>, and American Society of Hematology (ASH) regarding <a href=\"https:\/\/www.hematology.org\/education\/clinicians\/guidelines-and-quality-care\/clinical-practice-guidelines\/venous-thromboembolism-guidelines\/ash-guidelines-on-use-of-anticoagulation-in-patients-with-covid-19\" target=\"_blank\" rel=\"noopener noreferrer\">anticoagulation<\/a>.<sup><a href=\"#notes\">2,3<\/a><\/sup> The specifics of these guidelines and their timing in relation to key studies and publications will be summarized by clinical practice domain below. In addition, there are multiple important aspects of clinical care, like admission\/discharge criteria and laboratory monitoring, which are not covered by existing guidelines and where consensus across institutions may provide useful guidance.[\/vc_column_text][vc_column_text]<\/p>\n<h3>Participating Sites<\/h3>\n<p>[\/vc_column_text][vc_single_image image=&#8221;1236&#8243; img_size=&#8221;full&#8221; onclick=&#8221;img_link_large&#8221; img_link_target=&#8221;_blank&#8221;][\/vc_column_inner][\/vc_row_inner][vc_row_inner gap=&#8221;20&#8243; css=&#8221;.vc_custom_1622573877408{margin-top: 0px !important;padding-top: 0px !important;padding-left: 10px !important;}&#8221;][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1622573867019{margin-top: 0px !important;padding-top: 0px !important;}&#8221;][vc_column_text]Baylor University Medical Center &#8211; Dallas, TX<br \/>\nBeth Israel Deaconess Medical Center &#8211; Boston, MA<br \/>\nCedars-Sinai Medical Center &#8211; Los Angeles, CA<br \/>\nChristianaCare Health System &#8211; Newark, DE<br \/>\nDenver Health &#8211; Denver, CO<br \/>\nEmory University &#8211; Atlanta, GA<br \/>\nFroedtert Hospital\/Medical College of Wisconsin &#8211; Milwaukee, WI<br \/>\nJefferson Health &#8211; Philadelphia, PA<br \/>\nJohns Hopkins Bayview Medical Center &#8211; Baltimore, MD<br \/>\nMassachusetts General Hospital &#8211; Boston, MA<br \/>\nMayo Clinic &#8211; Rochester, MN<br \/>\nMaine Medical Center &#8211; Portland, ME<br \/>\nMiriam Hospital- Brown University &#8211; Providence, RI<br \/>\nMount Sinai Health System &#8211; New York, NY<br \/>\nOregon Health &amp; Science University &#8211; Portland, OR<br \/>\nOur Lady of the Lake &#8211; Baton Rouge, LA<br \/>\nRush &#8211; Chicago, IL<br \/>\nRutgers Robert Wood Johnson Medical School &#8211; New Brunswick, NJ<br \/>\nSan Francisco General Hospital &#8211; San Francisco, CA<br \/>\nStanford University &#8211; Palo Alto, CA<br \/>\nThe Ohio State Wexner Medical Center &#8211; Columbus, OH<br \/>\nTulane SOM &#8211; New Orleans, LA<br \/>\nUC Los Angeles &#8211; Los Angeles CA<br \/>\nUC San Diego &#8211; San Diego, CA<br \/>\nUC San Francisco &#8211; San Francisco, CA<br \/>\nUIHC &#8211; Iowa City, IA[\/vc_column_text][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1622573862423{margin-top: 0px !important;padding-top: 0px !important;}&#8221;][vc_column_text]UNC &#8211; Chapel Hill, NC<br \/>\nUniversity of Florida &#8211; Gainesville, FL<br \/>\nUniversity of Michigan &#8211; Ann Arbor, MI<br \/>\nUniversity Miami &#8211; Miami, FL<br \/>\nUniversity Health Network &#8211; Toronto, Ontario, Canada<br \/>\nUniversity of California Davis Medical Center &#8211; Sacramento, CA<br \/>\nUniversity of Chicago &#8211; Chicago, IL<br \/>\nUniversity of Iowa &#8211; Iowa City, IA<br \/>\nUniversity of Kentucky Healthcare\u00a0&#8211; Lexington, KY<br \/>\nUniversity of Minnesota &#8211; Minneapolis, MN<br \/>\nUniversity of Missouri-Columbia &#8211; Columbia, MO<br \/>\nUniversity of Nebraska &#8211; Omaha, NE<br \/>\nUniversity of Pennsylvania &#8211; Philadelphia, PA<br \/>\nUniversity of Washington Medical Center &#8211; Seattle, WA<br \/>\nHarborview Medical Center &#8211; Seattle, WA<br \/>\nUniversity of Wisconsin Hospital and Clinics &#8211; Madison, WI<br \/>\nUNM &#8211; Albuquerque, NM<br \/>\nUPMC &#8211; Pittsburgh, PA<br \/>\nUT Austin DMS \/ Dell Seton Medical Center &#8211; Austin, TX<br \/>\nVanderbilt University Medical Center &#8211; Nashville, TN<br \/>\nVCU Health System &#8211; Richmond, VA<br \/>\nWake Forest &#8211; Winston-Salem, NC<br \/>\nWashington University in St. Louis &#8211; St. Louis, MO<br \/>\nWeill Cornell &#8211; New York, NY[\/vc_column_text][\/vc_column_inner][\/vc_row_inner][vc_row_inner][vc_column_inner offset=&#8221;vc_hidden-lg vc_hidden-md vc_hidden-sm&#8221;][vc_wp_custommenu nav_menu=&#8221;24&#8243; el_class=&#8221;subNavButton2&#8243;][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221;][vc_column][cesis_line_divider width=&#8221;&#8221;][vc_column_text font_size=&#8221;10px&#8221; css=&#8221;.vc_custom_1622573345641{padding-top: 20px !important;padding-right: 20px !important;padding-bottom: 20px !important;padding-left: 20px !important;background-color: #f9f9f9 !important;}&#8221;]<a name=\"notes\"><\/a><\/p>\n<ol>\n<li>COVID-19 Treatment Guidelines Panel. <a href=\"https:\/\/www.covid19treatmentguidelines.nih.gov\/therapeutic-management\/\" target=\"_blank\" rel=\"noopener noreferrer\">Coronavirus Disease 2019 (COVID-19) Treatment Guidelines<\/a>. National Institutes of Health. Accessed March 15, 2021.<\/li>\n<li>Bhimraj A, Morgan RL, Shumaker AH, et al. <a href=\"https:\/\/www.idsociety.org\/practice-guideline\/covid-19-guideline-treatment-and-management\/\" target=\"_blank\" rel=\"noopener noreferrer\">Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19<\/a>. Accessed March 15, 2021.<\/li>\n<li>Cuker A, Tseng EK, Nieuwlaat R, et al. <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7869684\/\" target=\"_blank\" rel=\"noopener noreferrer\">American Society of Hematology 2021 guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19<\/a>. Blood Adv. 2021;5(3):872-888. doi: 10.1182\/bloodadvances.2020003763<\/li>\n<\/ol>\n<p>[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row_content_no_spaces&#8221; equal_height=&#8221;yes&#8221; content_placement=&#8221;bottom&#8221; css=&#8221;.vc_custom_1601408973850{margin-top: 0px !important;margin-bottom: 0px !important;border-bottom-width: 4px !important;padding-top: 0px !important;padding-right: 20px !important;padding-bottom: 0px !important;padding-left: 20px !important;background-color: #f2f2f2 !important;border-bottom-color: #2c5d73 !important;border-bottom-style: solid !important;}&#8221;][vc_column width=&#8221;1\/2&#8243; css=&#8221;.vc_custom_1599239336771{padding-right: 20px !important;padding-left: 10px !important;}&#8221;][cesis_icon_paragraph i_size=&#8221;20&#8243; heading=&#8221;Clinical Pathways &#8211; OVERVIEW&#8221; text=&#8221;&#8221; margin_top=&#8221;40&#8243; icon_color=&#8221;#f7941d&#8221; h_icon_color=&#8221;#f7941d&#8221; heading_color=&#8221;#f7941d&#8221; heading_h_color=&#8221;#f7941d&#8221; heading_f_size=&#8221;20px&#8221; heading_f_weight=&#8221;600&#8243; heading_l_height=&#8221;30px&#8221; heading_t_transform=&#8221;none&#8221; icon=&#8221;fa-page&#8221;][\/cesis_icon_paragraph][\/vc_column][vc_column width=&#8221;1\/2&#8243;][cesis_breadcrumb pos=&#8221;cesis_breadcrumb_right&#8221; force_font=&#8221;custom&#8221; bread_color=&#8221;#2c5d73&#8243; bread_hover_color=&#8221;#2c5d73&#8243; f_size=&#8221;10px&#8221; f_weight=&#8221;300&#8243; t_transform=&#8221;uppercase&#8221; [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1177,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/pages\/1232"}],"collection":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/comments?post=1232"}],"version-history":[{"count":14,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/pages\/1232\/revisions"}],"predecessor-version":[{"id":1374,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/pages\/1232\/revisions\/1374"}],"up":[{"embeddable":true,"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/pages\/1177"}],"wp:attachment":[{"href":"https:\/\/www.hospitalinnovate.org\/covid19\/wp-json\/wp\/v2\/media?parent=1232"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}