Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1191-1195 (doi:10.1542/peds.2008-0205)

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ARTICLE

Effectiveness of a Clinical Pathway for the Emergency Treatment of Patients With Inborn Errors of Metabolism

Dina J. Zand, MD^a,b, Kathleen M. Brown, MD^a,c, Uta Lichter-Konecki, MD, PD^a,b, Joyce K. Campbell, RN, MSN^d, Vesta Salehi, MD^e and James M. Chamberlain, MD^a,c

^a Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC; Divisions of
^b Genetics and Metabolism
^c Emergency Medicine
^d Center for Hospital-Based Specialties, Children's National Medical Center, Washington, DC
^e Department of Pediatrics, Weill Cornell Medical College, New York, New York

OBJECTIVE. The goal was to measure the effectiveness of a clinical pathway for the emergency department care of patients with inborn errors of metabolism.

METHODS. Two years after the implementation of a multidisciplinary clinical pathway for patients with inborn errors of metabolism in our urban, academic, pediatric emergency department, we compared measures of timeliness and effectiveness for patients treated before the pathway with the same measures for patients treated after implementation of the pathway. Measures of timeliness included time to room, time to doctor, time to glucose infusion, and total emergency department length of stay. Measures of clinical effectiveness included the proportion of patients receiving adequate glucose infusions, proportion of patients admitted, inpatient length of stay, and proportion of patients requiring PICU admission.

RESULTS. A total of 214 emergency department visits for patients with inborn errors of metabolism were analyzed, 90 before and 124 after initiation of the pathway. All measures of timeliness of care except total emergency department length of stay demonstrated significant improvement in comparisons of values before and after initiation of the pathway. Measures of clinical effectiveness also demonstrated significant improvements after initiation of the pathway. There was improvement in the proportion of patients who received adequate glucose infusions, with a decrease in the proportion of patients who required admission to the PICU. Emergency department length of stay, inpatient length of stay, and the proportion of patients admitted to the hospital were not affected.

CONCLUSIONS. Most measures of timeliness and 2 measures of effectiveness showed improvement after implementation of an emergency department pathway for patients with inborn errors of metabolism. Therefore, a clinical pathway can improve the emergency care of patients with inborn errors of metabolism.

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Key Words: quality of health care • critical pathways • emergency medical services • inborn errors of metabolism

Abbreviations: ED—emergency department • IEM—inborn error of metabolism • PRISA II—Pediatric Risk of Admission II

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Accepted Mar 10, 2008.

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