Innovative approach to tracking clinical variation in practice

Abstract

Clinical guidelines and pathways are developed to assist clinicians in decision-making, aiming to standardise and provide best-practice care. Understanding deviations from clinical pathways provides an opportunity to improve patient care processes and outcomes and provide clinicians with an objective, accurate and insightful picture of their practices. Existing literature primarily employs binary adherence measurement based on tabular patient data, often lacking the granularity to account for patient-specific conditions. In this study, we propose a novel approach for measuring deviations from clinical pathways by structuring patient data into an event stream, capturing the sequence of multiple activities throughout a patient’s care journey. Patient data, such as vitals measurements, clinical interventions such as investigation orders and results, and medication orders and results, will be presented utilising Fast Healthcare Interoperability Resource (FHIR) resources. We define deviation occurring when a clinician fails to complete an activity specified in the clinical pathway. Deviations will be identified by contrasting the activities in the pathway with those present in the patient’s event stream. A deviation score will then be calculated and adjusted based on weighting factors assigned to each activity and potential impact on patient condition, based on past strength of evidence. We can provide an innovative approach to deviation analysis and reporting. We will demonstrate the utility of this approach employing on a case series of sepsis management in the Emergency Departments at Western Sydney hospitals.