Clinical Pathways: Improving Child Health with Science – PediaCast 559

Show Notes


  • Drs Berkeley Bennett and Gerd McGwire visit the studio as we consider clinical pathways in pediatric medicine. Clinical pathways improve the delivery and efficiency of care, impact outcomes, contain costs, and boost family satisfaction. We explain how!


  • Clinical Pathways




Episode Transcript

Announcer:     This is Pediacast.

Announcer:     Welcome to Pediacast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr Mike Patrick:     Hello everyone and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Nationwide Children's Hospital. We're in Columbus, Ohio.

Dr Mike Patrick:     It's episode 559. We're calling this 1 Clinical Pathways Enhancing Child Health with Science.

Dr Mike Patrick:     I Want to welcome all of you to the program

Dr Mike Patrick:     before we get to clinical pathways and what they are and why they are so important. I just have a public service announcement for you here real quick. And that is, you know, it's kind of a tough time in the world right now. You know, we came through a pandemic together and you sort of hope for, I don't know, some easy living, a time of peace for a little while. But that's really not what we have.

Dr Mike Patrick:     We do have wars in multiple places that are impacting millions of people. Natural disasters, including early season tornadoes and floods and volcano eruptions. There's actually 84 wildfires in 13 States right now that are ravaging millions of acres. And all of this shows up on our television screens and our computers. And our kids hear about all of these things on those screens but also at school.

Dr Mike Patrick:     And so this is my occasional reminder, we have talked about this before, to regularly check in with your kids regardless of their age, whether they are young elementary school-aged children or teenagers, keep open those lines of communication and ask them what is on their minds. What are they hearing? What are they seeing? What are they reading? What questions do they have?

Dr Mike Patrick:     And how can we as parents best support them? You may not have the answers to their questions. There may not be good answers to their questions. You can at least help them think through the things that are concerning them. You can help them find the answers and have a discussion and talk and support.

Dr Mike Patrick:     Of course, we wanna do this in an age and developmentally appropriate Way so the way that we talk about a war to a seven-year-old and a 17 year old are of course going to be different But the point here really is to check in and to see how they're doing. And in the face of disasters, whether they are human made or natural disasters, there are plenty of them happening in the world right now. And these check-ins are really important. And if your child experiences anxiety or sadness, you know, address those things and make sure you get them the help that they need. And often the first step in doing that is just touching base with your child's doctor, especially if you think there are mental health concerns or you think that maybe they need more help and support than you are able to provide.

Dr Mike Patrick:     And speaking of that, make sure you get help and support for yourself because we are going to be able to support our kids best when we ourselves as adults are also well supported. So really important things to keep in mind. As we move on, we are going to talk about clinical pathways today and they're sort of like recipes in the medical world. You know, you have a particular disease process, oh we need to follow these steps. Or you have this set of symptoms.

Dr Mike Patrick:     This is the pathway we need to go down to figure out what is happening. So they hope to standardize care. They also incorporate the latest evidence, and they are updated and changed as we learn more. So as evidence changes, clinical pathways can also change. They help medical trainees learn best practices, they improve health outcomes, and they increase patient and family satisfaction.

Dr Mike Patrick:     But How are clinical pathways developed? Whose job is it to create them and evaluate them and update them? What sort of pathways are we talking about and how rigidly should they be applied? And how exactly do they improve efficiency and help reduce costs? We'll answer all of these questions and more as we consider clinical pathways.

Dr Mike Patrick:     And in our usual PDA Cast fashion, we have a couple of terrific studio guests who are going to help us as we consider clinical pathways. Dr. Berkeley Bennett is an emergency medicine physician and Dr. Yard McGuire is a hospital medicine physician, both of them at Nationwide Children's Hospital. Before we introduce our guests, don't forget, you can find PDA cast wherever podcasts are found.

Dr Mike Patrick:     We always appreciate when you leave a review wherever you listen to podcasts and we love connecting with you on social media. You'll find us on Facebook, Instagram threads, LinkedIn, and Twitter, or X, simply search for PDA cast. Also, don't forget we have that handy contact link over at If you would like to suggest a future topic for the program. Also want to remind you the information presented in every episode is for general educational purposes only.

Dr Mike Patrick:     We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your health care provider. Also your use of this audio program is subject to the Pediacast Terms of Use Agreement, which you can find at So let's take a quick break. We'll get Dr.

Dr Mike Patrick:     Berkeley Bennett and Dr. Yara McGuire settled into the studio, and then we will be back to talk about clinical pathways. It's coming up right after this. Dr. Berkley Bennett is an emergency medicine physician at Nationwide Children's Hospital and an associate professor of pediatrics at the Ohio State University College of Medicine.

Dr Mike Patrick:     Dr. Yard McGuire is a pediatric hospitalist at Nationwide Children's and a professor of pediatrics at Ohio State. Both have a passion for developing and implementing clinical pathways. These aim to improve the delivery of pediatric care and enhance health outcomes for children and teenagers seeking treatment at our hospital. That is the topic today, clinical pathways.

Dr Mike Patrick:     But first let's give a warm PDA cast welcome to our guests, Dr. Berkeley Bennett and Dr. Yara McGuire. Thank you both so much for being here today.

Dr Berkeley Bennett:     Thank you so much for having us here today. I'm really excited to chat with everybody about this.

Dr Gerd McGwire:     Thank you, Dr. Mike. It's a pleasure to be here.

Dr Mike Patrick:     Yeah, really so thankful that you both were able to take time out of your busy schedules and join us. Berkeley, I wanted to start with you. I think just giving us sort of a broad definition of what exactly is a clinical pathway, and then we'll talk more about why they are important.

Dr Berkeley Bennett:     Okay, sounds great. So the Nationwide Children's Hospital definition of a clinical pathway is a multidisciplinary plan of care that translates guidelines, evidence, and expert opinion onto local infrastructure and processes. So, that's a complicated sentence. So, to explain further, I will use the example of our febrile infant pathways. So, as we all know, it's very common for a young baby to get a fever.

Dr Berkeley Bennett:     Most fevers do not lead to serious illness, but we want to make sure that we can identify the cause of the fever while avoiding unnecessary tests and hospitalization. The American Academy of Pediatrics reviewed 40 years of research to develop a detailed guideline for evaluation and treatment of a young baby with fever. Our clinical pathway program collaborated with local infectious disease experts and frontline providers to combine recommendations from the national guideline with expertise and knowledge of local infections, and we created pathways that clearly outline how to best care for a young baby with a fever at our institution. So, pathways are designed to be complete but quick and easy to read references to help medical teams care for patients in real time. Pathways also call out opportunities for shared decision making with parents because we want to emphasize the critical role that parents play in the health of their child.

Dr Berkeley Bennett:     So we have pathways specific for our outpatient clinics, our urgent cares, emergency departments, and inpatient units to ensure that their recommendations are optimized for each clinical setting. And finally, not only do pathways promote the best delivery of health care, but they standardize the care so that we're providing the best quality to every patient.

Dr Mike Patrick:     Yeah. And, you know, I think that from a parent standpoint, there is some comfort in knowing that when you come to our hospital, hopefully for the most part, it doesn't really matter which physician you see, you're going to get the same treatment that's based on evidence most of the time. But the clinical judgment is still going to be important, right? So there are pathways, but they aren't necessarily rigid because there are data points that would make certain kids perhaps an exception, correct?

Dr Berkeley Bennett:     Absolutely. The pathways are really geared to be for 80% of the people with a certain disease process, but we recognize that there's going to be some that don't exactly fit the mold and we need to be make sure that we are thinking about that and while following the pathway knowing when we need to step off and do something different.

Dr Mike Patrick:     Yeah, yeah. And this is going to be important, as you had mentioned, sort of standardizes care, which is really nice. You can also then change the pathway as new evidence becomes available. So this isn't a 1 and done, right? You're constantly thinking about the pathways, thinking about the science behind the pathway, and then changing things if our understanding changes.

Dr Mike Patrick:     Is that correct as well?

Dr Berkeley Bennett:     Absolutely. Yes. And I think Yard can speak to this. She's been involved in doing pathways for a long time. We update them every 3 years, but often, more often, if we learn something new, we're like, ooh, let's make the pathway better because it can better fit the evidence and better care for our patients.

Dr Mike Patrick:     Yeah, yeah. And being a teaching hospital, so Nationwide Children's is affiliated with the Ohio State University College of Medicine. And so we do have a lot of trainees who are, you know, they're physicians, they've graduated from medical school, but they're still learning their craft, so to speak. And by having these pathways, I think it does help them start to think things through in a particular way that the rest of us are thinking it. So, you know, it just helps with training, standardizing all of that too.

Dr Berkeley Bennett:     Oh, absolutely. We try to gear our pathways so that they are, So they include enough details for an intern on their first day at the hospital so that they know exactly what to do and we can all work together to make sure we provide the best care.

Dr Mike Patrick:     Yeah, yeah. And sometimes it's good. So when I'm teaching, I'd like to actually ask the resident first, Okay, before we look at a pathway, what do you want to do and why do you want to do it? So there's still room for teaching and for folks to kind of come up with a plan on their own, but then you can sort of check yourself with the pathway to see, hey, am I missing something? Is there a different direction I should have been thinking.

Dr Mike Patrick:     But on the other hand, we don't necessarily want to create a cookbook, correct?

Dr Berkeley Bennett:     Correct. Correct. Absolutely.

Dr Mike Patrick:     Yeah. And then what are some of the examples of a clinical pathways that we have here at Nationwide Children's?

Dr Berkeley Bennett:     So we, right now, we have more than 80 clinical pathways at Nationwide Children's, and they are specific for the setting that the patients are going to receive their care. So our pathways represent a broad spectrum of pediatric conditions from common diseases such as an ear infection to rare diseases such as infections of the heart. We also have pathways that provide guidance for how to evaluate and manage injuries, how to safely provide sedation so that children don't feel pain during procedures, and for the process of life-saving interventions such as placing a tube in the airway to assist with breathing. We've got the whole spectrum. Pretty much anything you need, we've developed a pathway for.

Dr Mike Patrick:     Yeah, and you always have your thinking caps on and thinking, okay, what is the next pathway that we could develop?

Dr Berkeley Bennett:     Yes, absolutely. Now, 1 thing

Dr Mike Patrick:     I love, and the reason that we have both of you on our program today, is we have the emergency medicine perspective and we have the hospitalist perspective. And as we're thinking about pathways, certainly care often gets started in the emergency department. And then if a child is ill enough to be admitted to the hospital, then that care continues as an inpatient. And we want there to sort of be agreement on these pathways and, you know, overall, what is the best for the kid, regardless of if they're in the emergency department or if they're in a hospital room upstairs. So this multidisciplinary approach is really important for clinical pathways.

Dr Mike Patrick:     From a practical standpoint, yard, how does a multidisciplinary team come together and work on these in the best interest of the kid, despite different lenses?

Dr Gerd McGwire:     Yes, that's a really excellent point, Mike, because I think, as most of us know, modern, high-quality healthcare really is a team sport, if you put it that way. When a child is in the emergency room or admitted to the hospital or even could be a routine clinic visit, The parent and the child meets nurses, could be pediatrician, or maybe some specialists, such as a pulmonologist or a cardiologist, and often 1 or more of many other healthcare professionals we have, such as the dieticians and respiratory therapists, occupational therapists, social worker, pharmacists, psychologists, and so on and so forth. As Berkeley explained, our clinical past really outlined our hospital's best practice, meaning the type of care that is most likely to make a child or a patient improve or recover from an illness or stay healthy. So best practice care is really delivered by each and all members of the healthcare team. So we also need to come together and develop and implement our best practice clinical pathways as a team.

Dr Gerd McGwire:     And also, as you mentioned, the outpatient, ER, inpatient, passive teams comes together to make sure our pathway aligned so that the transitions between care settings like the ER to the inpatient is smooth for our parents and patients.

Dr Mike Patrick:     Yeah, yeah. I love that pharmacy is involved. They always have have a great viewpoint and certainly help us in clinical practice. And I would imagine nursing is also a part of your team?

Dr Gerd McGwire:     Very much so. Nurses are the ones who deliver a lot of the cares. Doctors might make clinical decisions, but our nurses is truly the frontline providers that care for each patient.

Dr Mike Patrick:     And then we mentioned that these pathways are evidence-based. How do you look at the literature? And sometimes literature can contradict itself. You know, there may be, you have to really look at how studies were done. Could the methods change the results that you get so that 1 study might show some different results than another?

Dr Mike Patrick:     How do you use the whole body of medical research to come up with a pathway, especially when there might be some things that don't agree with 1 another?

Dr Gerd McGwire:     Yeah, that's another great point. And evidence is really the things that triggered the development of clinical pathways, because the rate at which new evidence, new information becomes available is really tremendous. And it has become impossible for individual doctors and nurses, regardless how dilettante they are, to keep up with that hospital providing support. Also, even if you know what the new evidence shows, you need to develop new processes to deliver the new, sometimes very technologically complex treatments to every patient that comes to our hospital. In the past, before clinical pathways were really used, it took about 17 years for a new research evidence to be implemented as standard patient treatment.

Dr Gerd McGwire:     And even after a national organization publish a guideline, it can take many years until that recommendation reaches the patient. So to try to speed up this process, clinical paths has really started to be developed. It first happened in the 1980s to improve the quality and value of care for adults with stroke and heart attacks. You know, pediatric research has given us many new ways to treat asthma, pneumonia, epilepsy, appendicitis, newborn jaundice, just to mention a few. So, About 20 years ago, pediatric providers started to develop clinical pathways for these and other conditions to really make sure that patients receive the benefits of new research fundings as soon as possible.

Dr Mike Patrick:     Yeah, and It's easy to see how that happens, where you train, you learn to do things a certain way, you go out into practice, and especially if you're not affiliated with a college of medicine, you don't necessarily have medical students and residents and nursing students, you can very easily get into sort of a rut in terms of how you practice, which served you well back then, but as new evidence becomes available, may not be serving your patients so well today. And so these clinical pathways, you know, we were talking about them in the context of a big hospital and a big pediatric healthcare institution, but even individual private practices could use clinical pathways to sort of standardize care and keep things up to date, even if you just have 3 or 4 doctors in a practice, right?

Dr Gerd McGwire:     Absolutely. And our pathways are on our own hospital's internet site, but also on the internet side for that purpose. And a lot of other hospitals do the same thing because we do want to share and collaborate for all our patients' best interests.

Dr Mike Patrick:     And then what is the implementation process look like? So you get a multidisciplinary team together, you decide that a particular topic is something good to have a pathway for and Berkeley had mentioned some of the ones that we have here, that there's lots of them. How do you go about then sort of getting that approved through sort of the chain of command of the hospital and then actually getting it implemented into the electronic health record?

Dr Gerd McGwire:     Great question. And fortunately, we've had a really great support by our hospital for our program and this whole process to develop clinical pathways and I think that is a key thing. You can't do clinical pathways without the support of your institution. So the main 3 ways to use implement or to facilitate the evidence-based practice is through pathways, is by education to care providers, especially doctors and nurses in training. They use electronic or clinical tools that makes it easier to prescribe or order best care than not doing so.

Dr Gerd McGwire:     And as I mentioned, keeping track of new evidence, we, our password develop team, with the help of our great experienced medical librarians, continually search for new evidence, review the new evidence, and discuss if the evidence is really sufficient for us to revise the care that we're providing, meaning will it actually improve the outcome and quality of life of our patients? And if the team think the answer, yes, we will revise the care we provide to be even better and that could be more effective, more efficient or safer.

Dr Mike Patrick:     Yes. And then in terms of once they are implemented, so we have, you know, you've got your team, it's been approved through the medical director of the hospital. And then we use digital tools to actually manage the day-to-day work of the pathway. For example, if in the electronic medical record, if a kid comes in wheezing in the emergency room, you're going to get access to the asthma order sets and a link to the pathway and all of those things. Then how do you go about reviewing those as new research comes out?

Dr Mike Patrick:     So Berkeley mentioned that they are reviewed and re-approved every 3 years, but is there ongoing evaluation as well so that things could be changed sooner?

Dr Gerd McGwire:     Yes, absolutely. Each pathway team has an expert in that field that the pathway is. So if there's a new research funding that tells us this is something we need to implement sooner, we can update the pathway at any time.

Dr Mike Patrick:     Yeah, yeah. And So the febrile infant, for example, if a baby comes in with a fever, you look at how old they are and whether they were premature or not. And then the infectious disease people may say, hey, the American Academy of Pediatrics has these new guidelines. We wanna make sure that those are kind of cooked into our pathway, even though we're not at the three-year mark, but because as infectious disease doctors, they're looking at these things and thinking about it and sort of keeping up to date, they're gonna be in a good position to say, hey, we need to rethink this.

Dr Gerd McGwire:     Yes, this is absolutely true. And for our asthma care, our asthma pathway, we've almost worked on continuously for the last year. So it's definitely an ongoing process.

Dr Mike Patrick:     Yeah, yeah. And Berkeley, in terms of patient safety, how do clinical pathways impact that? It's so important to keep our patients safe and make sure we're doing the right things. How do clinical pathways help us do that?

Dr Berkeley Bennett:     That's a great question and that's something that we really focus on. As Yarn had mentioned, pathways are developed by a big multidisciplinary team. And so the expertise of each team member is critical to making sure patient safety is optimized. An example of this is the emergency department pathway about providing medications to reduce pain during procedures. For instance, if a child comes in to the emergency department with a broken arm and it needs to be straightened, we want to make sure that we reduce pain as much as possible during that procedure.

Dr Berkeley Bennett:     So the clinical pathway utilizes the expertise of doctors, nurses, and pharmacists to provide guidance on, first of all, who is safe to be sedated in the emergency department, what medications are safe and effective, and then details about how to monitor and keep the patient safe.

Dr Mike Patrick:     Yeah, so really we have all of the experience of pediatrics from a national standpoint to really have an idea of what's safe, what's not safe, what are other places doing, what's the latest research. And so by taking all of those things into account, we really are keeping our patients as safe as possible. And it's not only safety, but there's also an efficiency that comes into play, correct, Berkeley?

Dr Berkeley Bennett:     Yes, absolutely. So each pathway includes information on how to recognize and evaluate for a specific condition and how to management. It's all in 1 document. You don't have to go ask a friend, you don't have to look up in a textbook, it's all right there, everything that you should need. What we've been able to do, which is really fun, is we have a main algorithm that outlines what to do, but then within the algorithm, there's links to separate pages that give you additional information.

Dr Berkeley Bennett:     You can take a quick look, know exactly what to do, but if you're like, oh I want to understand that a little bit better, you click the link and the information is right there. Well each pathway incorporates all this national evidence. We make it specific for a hospital because sometimes you need to know how to navigate care in our own institution and it includes details on how to do that.

Dr Mike Patrick:     Yes, so important. And in terms of efficiency too, there may be instances where nurses can go ahead and order something. I'm thinking especially in the emergency department. So if a kid with asthma comes in, we know it's going to be important to get the bronchodilators, things are going to open up the airways and get steroids going as soon as we possibly can and that may even be before they see a physician because some particular intervention is on a pathway.

Dr Berkeley Bennett:     Yes, absolutely.

Dr Mike Patrick:     Yeah. And then, Yard, in terms of outcomes, so we say this is safe, it's more efficient. Do clinical pathways actually impact health outcomes?

Dr Gerd McGwire:     Yes, they definitely do. And initially, we just kind of assumed that they do or looked at their own pathways, but now it has been published in lots of studies that they actually do. For example, the rate of side effects and complications that patients might experience decrease when pathways are used because the pathways help doctors, especially new doctors, the doctors in training, identify and use the most effective treatments and often avoid using treatments that are not effective but can still cause side effects. Also, as clinical pathways make our care more effective and efficient, like you mentioned, patients recover faster. This means that their stay in the hospital has become shorter and some hospitals admissions have been diverted altogether.

Dr Mike Patrick:     Yeah, because we're doing what needs to be done more quickly And so there's definitely that efficiency, you know, and that goes back to the asthma example where if you get the bronchodilators and the steroids started early in their emergency department stay, they may get better before that decision to admit or not to admit takes place. Whereas if they've been there an hour and they're just now getting their medicine to help them and they've already been sitting around the ER, you're more likely to be like, well, that kid needs to be admitted. They sound terrible and they've already been here an hour, but they didn't really have a full hour to see if that treatment was going to work. So I would imagine that not only is it more efficient in terms of shorter hospital stays, but then that becomes more cost-effective as well because you may not have to have as many resources, you may not be casting as wide of a net in terms of studies that you order, labs, x-rays, those sorts of things. If you're sticking to a pathway, and we know it's a safe pathway, we may be able to save money that the healthcare in general is costing us as a society.

Dr Gerd McGwire:     Yes, definitely. Healthcare is really expensive, as I think all of us know, especially a stay in the hospital. And I think asthma, like you pointed out, is a great example where we've collaborated actually for the last 10 plus years with emergency room physicians like you in Berkeley, ICU physicians, pharmacists, outpatient provider, and all us inpatient providers to make the care more efficient and cost them much less. So it's really about providing the best care at the right time, which as you said, decreases the time the child has to stay in the hospital. And not only does it decrease the hospital costs, it also decreases the loss of income that parents might experience when their child is in the hospital.

Dr Gerd McGwire:     So we really work to increase the value of care with clinical pathway, which means providing the highest quality of care at the best cost. And decreasing the use of unnecessary treatment is a very common way that increases the value of the care we provide with clinical pathways.

Dr Mike Patrick:     Yeah, absolutely. Berkeley, do we find that patients and families, do they realize these pathways are happening or is it just something that's sort of under the surface? And if they do have an understanding of pathways, does this increase their satisfaction with the care that they're given?

Dr Berkeley Bennett:     So I think, that's a great question. I think a lot of times the pathways are happening and the families may not really be aware of it. It's just part of our efficient way that we deliver care and it's just happening. But there are times when I will bring up a pathway when I'm explaining a treatment plan to a family and I'm able to show them what the evidence says and even engage them in deciding what's best for their child. So by showing them, yes, we've done the research, we have the evidence, we've collaborated, and then including them in visualizing it, it can really show that everybody can be on the same page about the care plan

Dr Mike Patrick:     Yeah And I would think that that's a really important in in the emergency department setting a lot of times parents come in With sort of a preconceived idea of what may or may not happen and that may be based on past experiences and certainly things change and so maybe we're not doing things exactly the same way that we did before, or it may be because they've talked to a neighbor or a family friend or maybe they have a relative who's a physician and you know a pediatrician in Oklahoma. And so come in with an idea of what ought to happen. And sometimes that is not the idea that we think ought to happen. And so I think having that pathway is sort of a common ground to discuss what we're doing and why we're doing it and to hear their concerns and maybe to say, well, this is the reason that we're not gonna do such and such. I mean, it just kind of gives you a concrete thing to carry a conversation around.

Dr Mike Patrick:     So I think that's really helpful for both clinicians and families in that sense.

Dr Berkeley Bennett:     Yes, absolutely. Like I pulled up the pathways and when I'm in the room with a family to show them, we've often printed them out. The families can take time and read them and I found it to be really valuable.

Dr Mike Patrick:     Yeah, yeah, absolutely. And I think Yard, you know, made the point that you can't know everything, right? I mean, you have to, as new knowledge comes out, we have to look things up and we have to sort of know what we don't know. And it is so nice just having all that information in 1 place so we know where to find it when we need it. And especially some of the disease processes that we don't see incredibly often.

Dr Mike Patrick:     I mean, often enough that we understand them and know them and know what to do, but maybe just as an example, I'm thinking about during the pandemic, we had Miss C, where we would have very intense inflammation and it could cause heart problems after COVID. And there was a whole panel of tests that we ought to do. And it's really hard to memorize all of that. And so having it all in 1 place to look it up, but knowing, well, I know there's a lot of things I need to do, where do I find that and then and get that done is just so helpful for efficiency and safety in pediatric practice for sure. 1 other thing that I wanted to mention is because our pathways are specific to Nationwide Children's, and I know you said they're on the intranet, they're on the internet, so, you know, pediatricians that practice in our community can find them and use them.

Dr Mike Patrick:     What happens when there may be a different pathway from 1 institution to another? Is that something like if I go to Dayton Children's or Cincinnati Children's, am I gonna get different care than at Nationwide Children's Berkeley?

Dr Berkeley Bennett:     That's a great question. And you really, so many institutions have their own pathway programs and produce their own pathways and they have their individual processes for doing that. And we often, when we're developing a pathway, we'll look at like, oh, what are other people doing just to get kind of a sense? And then we look at the evidence. And So you'll see that there are commonalities amongst pathways at different institutions across the country.

Dr Berkeley Bennett:     What's different is how we navigate the care at our institution, depending on potentially local disease burden or resources or just how do we do things here based on the expertise at our institution. Those will be the subtle differences. So the care really should be the same, but it's necessary to make it specific for the institution just because that's where you are and that's going to make it the best care possible.

Dr Mike Patrick:     Yeah, yeah. And The other thing too I think that's important is that there can be in some instances a clear better way of doing things based on evidence. But sometimes there may be more than 1 way to do something safely, efficiently, Because medicine is not always cookie cutter and there may be more than 1 OK way to do something and then you can't have differences from 1 place to another. Would you agree with that?

Dr Berkeley Bennett:     Yes, absolutely. Yeah. You know, there are different ways of approaching things different. You know, you can get all the labs up front, you can do it stepwise. It really just depends on kind of the experts in that location and how they feel we can deliver the best care for the people in our community.

Dr Mike Patrick:     Yeah, and it's sometimes things, you know, you may have 2 different ways of doing something and 1 has an advantage in 1 respect and another has an advantage in another respect. 1 of the things that I think about with this is dosing medicines, whether you do it once a day, twice a day, 3 times a day. The fewer number of doses certainly is going to help improve compliance, but when you do smaller doses divided, you're going to get better steady-state levels of the drug in the bloodstream so that it's working more around the clock. So sometimes it is a struggle to know which is the right way because both ways may have their own set of advantages.

Dr Berkeley Bennett:     Yeah, absolutely. And that's something that when we work with a multidisciplinary team, we talk with say the pharmacist and say, okay what's better? You know, we'd like to decrease that how often we're dosing this but does it really make sense And we can get a lot of input on that.

Dr Mike Patrick:     Yeah, yeah. And that's something that then from 1 institution to another, you may have a group of pharmacists at 1 place that put more of importance on 1 thing versus another, and that can make things change. And so just because you do have disagreements to a degree within Pathways, they've still both ways have been thought out by experts, which I think is comforting for parents.

Dr Gerd McGwire:     I just want to reiterate what you and Berkeley said. Pathways really are a resource for physicians or providers and parents to get the knowledge what best practice is. But it really is the individual doctor together with the patient and the caregivers who decide what, how to use the pathway and to decide what is the best care for each individual patient based on his and hers individual situation.

Dr Mike Patrick:     Yeah, I love that so much. This, the whole idea of shared decision-making. And from a parent's point of view, you know, you always, you're always thinking about, okay, what is best for my child? And from the parent point of view, part of what is best for my child is do we really need to stick them again for a lab value that maybe we don't really need? Whereas the physician is more like, well, I want to do the best thing for the child and that is knowing what this lab value is.

Dr Mike Patrick:     And so sometimes coming together and thinking about risks and benefits and sort of talking it out and making a decision together based on the unique data points of a particular family situation. It's just so important and I'm sure that just in and of itself improves patient satisfaction when they feel like they are actually having a seat at the table and are part of the conversation because they love their kid and they want what's best for their child too. They just may have different priorities, right?

Dr Gerd McGwire:     Yeah, and getting parents more involved so we can include their experience and opinions. It's really something that we want to get better on when we develop our pathway. So hopefully more to come on that.

Dr Mike Patrick:     Yeah, absolutely.

Dr Berkeley Bennett:     Yeah, it's such a great point. And even I love how like bringing up our febrile infant pathways, again, we actually have boxes that say shared decision-making with parents because the evidence you could go either way. And so we have information about, okay, if your child is diagnosed with a particular virus, are they still at risk for a bacterial infection? And what is that risk? And you can sit down with a parent and say, okay, how much risk are we willing to tolerate?

Dr Berkeley Bennett:     Because what we're looking at might be another needle stick, it might be another procedure, and we can share, make that decision together so that they can really participate in what's best for their child.

Dr Mike Patrick:     Yeah, yeah, absolutely. And we are going to have a link to Clinical Pathways at Nationwide Children's Hospital. So we mentioned that they are available on the internet for anyone to look at. They're not behind a wall. And so we'll have a link to that page in the show notes for this episode, 559 over at

Dr Mike Patrick:     We'll also have links to emergency medicine and hospital medicine at Nationwide Children's if you'd like to learn more about what Berkley and Yard do on a day-to-day basis. So those will be in the show notes for you as well. So once again, Dr. Berkley Bennett with Emergency Medicine and Dr. Yard McGuire with Hospital Medicine, both at Nationwide Children's Hospital.

Dr Mike Patrick:     Thank you so much for stopping by and chatting with us today.

Dr Berkeley Bennett:     Oh, thank you for having me. This has been really wonderful.

Dr Gerd McGwire:     Thank you very much for this opportunity to talk about the clinical pathways, our passion.

Dr Mike Patrick:     We We are back with just enough time to say thanks once again to all of you for taking time out of your day and making Pediacast a part of it. Really do appreciate that. Also, thanks once again to our guests this week, Dr. Berkeley Bennett with emergency medicine and Dr. Yara McGuire with hospital medicine, both at Nationwide Children's Hospital.

Dr Mike Patrick:     Don't forget you can Find us wherever podcasts are found or in the Apple and Google podcast apps. I heart radio, Spotify, SoundCloud, Amazon music, YouTube, and most other podcast apps for iOS and Android. Our landing site is You'll find our entire archive of past programs there, along with show notes for each of the episodes, our terms of use agreement and the handy contact page if you would like to suggest a future topic for the program. Reviews are helpful wherever you get your podcasts.

Dr Mike Patrick:     We always appreciate when you share your thoughts about the show and we love connecting with you on social media. You'll find us on Facebook, Instagram, threads, LinkedIn, and Twitter X. Simply search for Pediacast. I've listened to this program. We have another 1 actually called Pediacast CME.

Dr Mike Patrick:     That stands for continuing medical education. It's targeted for healthcare providers. So if you take care of kids in any capacity, that program is for you. It's similar to this 1. We do turn the science up a couple notches and offer free continuing medical education credit for those who listen And that includes physicians, of course, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.

Dr Mike Patrick:     And since Nationwide Children's is jointly accredited by all of those professional organizations, it's likely we offer the exact credits you need to fulfill your state's continuing medical education requirements. Of course, you want to be sure the content of the episode matches your scope of practice. Shows and details are available at the landing site for that program, You can also listen wherever podcasts are found. Simply search for pediacastcme.

Dr Mike Patrick:     Thanks again for stopping by. And until next time, this is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long everybody.

Announcer:     This program is a production This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on Pediacast.

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