Clinical pathways and diagnostic reasoning: A qualitative study of pediatric residents' and hospitalists' perceptions

Abstract

Background: Clinical pathways are evidence-based guidelines adapted to local settings. They have been shown to improve patient outcomes and reduce resource utilization. However, it is unknown how physicians integrate clinical pathways into their clinical reasoning. Methods: We conducted a single-center qualitative study involving one-on-one semi-structured interviews of pediatric residents and pediatric hospitalist attendings between August 2021 and March 2022. Interviews were audio-recorded and professionally transcribed. We utilized a qualitative descriptive framework to code data and identify themes.Results: We interviewed 15 pediatric residents and 12 pediatric hospitalists.Thematic analysis of interview transcripts revealed four themes related to physician utilization of and experience with clinical pathways: (1) utility as a tool, (2) means of standardizing care, (3) reflection of institutional culture, and (4) element of the dynamic relationship with the clinician diagnostic process. These themes were generally common to both residents and attending physicians; however, some differences existed and are noted when they occurred.Conclusions: Clinical pathways are part of many clinicians' diagnostic processes.Pathways can standardize care, influence the diagnostic process, and express local institutional culture. Further research is required to ascertain the optimal clinical pathway design to augment and not inhibit the clinician's diagnostic process.

Building clinical pathways of the future that improve safety and reduce waste in healthcare

“…Clinical pathways synthesize the best evidence supporting the diagnostic workup for specific diseases and have the potential to enhance diagnostic excellence when used appropriately. In the qualitative study by Fatemi et al 3 in this issue of Journal of Hospital Medicine , pediatric residents and hospitalists shared their attitudes and experiences related to a clinical pathway for the diagnosis and management of community‐acquired pneumonia (CAP). Understanding how end users perceive clinical pathways is crucial since such innovations to improve care are only helpful to the extent they are taken up in practice.…”

“…Clinical pathways synthesize the best evidence supporting the diagnostic workup for specific diseases and have the potential to enhance diagnostic excellence when used appropriately. In the qualitative study by Fatemi et al 3 This could reduce diagnostic errors, improve the safety of patients, and reduce overuse and waste in health care. Future clinical pathways should aim to be effective in reducing harm to patients as well as the environment.…”