Appl Clin Inform 2020; 11(04): 535-543
DOI: 10.1055/s-0040-1715478
Research Article

Development of a Web-Based Nonoperative Small Bowel Obstruction Treatment Pathway App

Heather Lyu
1  Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
2  Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Caitlin Manca
2  Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Casey McGrath
2  Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Jennifer Beloff
2  Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Nina Plaks
3  Partners HealthCare, Somerville, Massachusetts, United States
,
Anatoly Postilnik
3  Partners HealthCare, Somerville, Massachusetts, United States
,
Amanda Borchers
3  Partners HealthCare, Somerville, Massachusetts, United States
,
Nicasio Diaz
3  Partners HealthCare, Somerville, Massachusetts, United States
,
Sean McGovern
3  Partners HealthCare, Somerville, Massachusetts, United States
,
Joaquim Havens
1  Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
2  Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Allen Kachalia
4  Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States
,
Adam Landman
1  Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
3  Partners HealthCare, Somerville, Massachusetts, United States
5  Armstrong Institute for Patient Safety and Quality, Johns Hopkins Hospital, Baltimore, Maryland, United States
› Author Affiliations
Funding H.L. is supported by the National Library of Medicine Institutional training grant for research training in biomedical informatics and data science (T15) under award number T15LM007092. There were no other funding sources. Corresponding author had full access to all the data in the study and had final responsibility for the decision to submit manuscript.

Abstract

Objective An electronic pathway for the management of adhesive small bowel obstruction (SBO) was built and implemented on top of the electronic health record. The aims of this study are to describe the development of the electronic pathway and to report early outcomes.

Methods The electronic SBO pathway was designed and implemented at a single institution. All patients admitted to a surgical service with a diagnosis of adhesive SBO were enrolled. Outcomes were compared across three time periods: (1) patients not placed on either pathway from September 2013 through December 2014, (2) patients enrolled in the paper pathway from January 2017 through January 2018, and (3) patients enrolled in the electronic pathway from March through October 2018. The electronic SBO pathway pulls real-time data from the electronic health record to prepopulate the evidence-based algorithm. Outcomes measured included length of stay (LOS), time to surgery, readmission, surgery, and need for bowel resection. Comparative analyses were completed with Pearson's chi-squared, analysis of variance, and Kruskal–Wallis tests.

Results There were 46 patients enrolled in the electronic pathway compared with 93 patients on the paper pathway, and 101 nonpathway patients. Median LOS was lower in both pathway cohorts compared with those not on either pathway (3 days [range 1–11] vs. 3 days [range 1–27] vs. 4 days [range 1–13], p = 0.04). Rates of readmission, surgery, time to surgery, and bowel resection were not significantly different across the three groups.

Conclusion It is feasible to implement and utilize an electronic, evidence-based clinical pathway for adhesive SBOs. Use of the electronic and paper pathways was associated with decreased hospital LOS for patients with adhesive SBOs.

Protection of Human and Animal Subjects

No human subjects were involved in the project.




Publication History

Received: 30 March 2020

Accepted: 01 July 2020

Publication Date:
19 August 2020 (online)

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