Are emergency department clinical pathway interventions adequately described, and are they delivered as intended? A systematic review

Abstract

Introduction: The accurate reproduction of clinical interventions and the evaluation of provider adherence in research publications improve the evaluation and implementation of research findings into clinical practice. We sought to examine the proportion of clinical pathway publications in an emergency department setting that adequately reported the following: (1) the exact reproduction of the clinical pathway that was implemented in the study, (2) the adherence to and correct execution of the clinical pathway intervention, and (3) the presence of a pre-implementation education phase. Methods: We performed a descriptive systematic review of the literature from 2006 to 2015 using MEDLINE, EMBASE, CENTRAL, and CINAHL. All types of prospective trial designs were eligible. Validated clinical pathway criteria were used to identify relevant publications. Two reviewers independently collected data using a piloted data abstraction tool. Risk of bias was assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Tool and the Newcastle-Ottawa Scale. Results: We identified 5947 publications, 44 of which met our inclusion criteria. The formal clinical pathway was fully reproduced in 27 (61%) publications, partially reproduced in 9 (21%), and not reproduced in 8 (18%). Only 14 (32%) studies reported whether at least one decision step was executed correctly. The presence of a pre-implementation education phase was reported in 33 (75%) studies. Conclusion: The underreporting of intervention elements may present a barrier to both the evaluation and accurate replication of clinical pathway interventions. These finding may be useful for the elaboration of complex intervention reporting guidelines, improved reporting in future clinical pathway publications, and improved knowledge translation and exchange of clinical pathway interventions.

Validation of descriptive clinical pathway criteria in the systematic identification of publications in emergency medicine

“…69 In our case, missing information about the roles and responsibilities of the different disciplines involved in study interventions may have lead to studies being inadvertently excluded and therefore contributing to selection bias. 66…”

“…Furthermore, most reporting guidelines of complex interventions do not provide detailed direction on this matter. 66,70,71…”

Specifying sickle cell disease interventions: a study protocol of the Sickle Cell Disease Implementation Consortium (SCDIC)

“…In recent years, there has been a growing awareness of the need for transparency in studies to increase scientific reproducibility, including the launch of the clinicaltrials.gov in 2000, a registry where researchers record their methods and outcomes measures, and development of guidelines such as CONSORT [ 25 ], TIDier [ 26 ], and STaRI [ 27 ], to support transparency in research. Ideally these initiatives would facilitate replicability of major findings; however a number of studies have failed to replicate prominent findings or failed to achieve expected outcomes [ 28 – 31 ]. Insights from researchers reveal that, among other issues, the absence of clear descriptions of studies, including hypotheses for outcomes and descriptions of their interventions strategies [ 31 , 32 ] make these studies virtually unusable, as they cannot be replicated, leading to inefficient use of research efforts and millions of dollars and efforts [ 33 ].…”

“…Ideally these initiatives would facilitate replicability of major findings; however a number of studies have failed to replicate prominent findings or failed to achieve expected outcomes [ 28 – 31 ]. Insights from researchers reveal that, among other issues, the absence of clear descriptions of studies, including hypotheses for outcomes and descriptions of their interventions strategies [ 31 , 32 ] make these studies virtually unusable, as they cannot be replicated, leading to inefficient use of research efforts and millions of dollars and efforts [ 33 ]. Unfortunately, the lack of detailed description of the interventions, including theoretical justification and review of the literature, is still prominent despite the push for publication guidelines [ 33 , 34 ].…”

Make care coordination a high priority

“…Adjemian et al performed a descriptive systematic review to examine the proportion of clinical pathway publications in an emergency department setting that adequately reported: (1) the exact reproduction of the clinical pathway that was implemented in the study, (2) the adherence to and correct execution of the clinical pathway intervention and (3) the presence of a pre-implementation education phase (recommendation #9). 4 Baldewijns et al present a study proposal for the INTERACT-in-HF study aiming to explore the current processes of Heart Failure care and to identify barriers and facilitators for improvement of Heart Failure care and guideline adherence in three regions in the North-West of Europe (recommendation #10). 6 …”