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Tools For Clinicians

Clinical pathways are multidisciplinary guides that assist clinicians to manage patients with specific conditions over a given time. The purpose of a clinical pathway is to improve the continuity and coordination of care across different disciplines and specialties involved in patient care. The use of a specific pathway for a specific patient occurs once the patient is admitted and a diagnosis is made.

Starting at emergency room arrival

Pediatric patients are often unstable and may not have a definitive diagnosis upon arrival. For these reasons, our clinical pathways include patient care during assessment and diagnosis.

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With the goals of improving patient care and increasing support for community health centers, we this resource for clinicians in our community. Please see privacy and terms of use.

Emergency Room Clinical Pathways for Pediatric Patients

Clinical Pathway: Adult and Pediatric Allergy and Anaphylaxis
Goals: 1) Identification and treatment of patient with anaphylaxis or severe allergic reaction including recognition of early signs and initiation of prompt action. 2) Create an interdisciplinary, consistent approach to treatment and care. 3) Provide patient education regarding allergic reaction, prevention and management of future allergic reactions.

Clinical Pathway: Asthma
Goals: 1) Identification and treatment of pediatric patients with asthma. 2) Create a team-oriented approach to treatment and care. 3) Decrease respiratory distress.

Clinical Pathway: Bronchiolitis
Goals: 1) Provide a consistent evidence-based approach to the diagnosis and management of bronchiolitis. 2) Create a team-oriented approach to efficient evaluation including use of RAS scoring. 3) Support diagnosis by history and physical examination. 4) Reduce routine use of bronchodilators and corticosteroids. 5) Reduce x-rays for use in diagnosis.

Clinical Pathway: Croup
Goals: 1) Identification and treatment of pediatric patients with croup. 2) Create a team-oriented approach to treatment and care. 3) Identify and distinguish mild, moderate and severe croup and prevent impending respiratory failure.

Clinical Pathway: Diabetic ketoacidosis (DKA)
Goals: 1) Initiate prompt, care of the pediatric patient presenting with DKA. 2) Minimize / decrease risk of complications through slow decrease in blood glucose of 50-100mg/dl/hour until glucose <300. 3) Correction of dehydration and hyperglycemia, resolution and anticipation of electrolyte abnormalities, identification of precipitating and co-morbid illnesses through coordinated care and close patient monitoring.

Clinical Pathway: Fever / Suspected Sepsis (30-90 days)
Goals: 1) Identification and treatment of infants 30-90 days with presenting complaint of documented fever >38 R. 2) Create a team-oriented approach to efficient and timely evaluation and work-up. 3) Antibiotic administration within 60 minutes for acutely ill/toxic appearing infants.

Clinical Pathway: Neonatal Fever/Suspected Sepsis
Goals: 1) Rapid identification and treatment of infants less than or equal to 30 days (or corrected age of less than 30 days) with presenting complaint of documented fever >38 R. 2) Create a standardized team-oriented approach to efficient and timely evaluation and work-up. 3) Antibiotic administration within 60 minutes.

Clinical Pathway: Neonatal Jaundice/ Suspected Hyperbilirubinemia
Goals: 1) Identification and initiate prompt treatment of infants less than 7 days with jaundice/ suspected hyperbilirubinemia. 2) Create a standardized team-oriented approach to efficient and timely evaluation and work-up. 3) Create a standardized admission criteria for infants with hyperbilirubinemia. 4) Initiate phototherapy for known admission delays.

Clinical Pathway: Neutropenic Fever
Goals: 1) Rapid identification/treatment of pediatric patients w/neutropenia and fever. 2) Create an efficient team-oriented approach in conjunction with Peds Hem/Onc (PHO service). 3) Antibiotic administration within 60 minutes of arrival. 4) Ensure stability of patient after antibiotic administration prior to admission to the floor.

Clinical Pathway: New or Acute Psych / Behavioral Assessments of Minors
ER clinical pathway for new or acute psych / behavioral assessments of minors.

Clinical Pathway: Pediatric Dehydration
Clinical pathway for dehydration at Doernbecher Children's Hospital.

Clinical Pathway: Pediatric DK
Clinical Pathway Treatment Process for Diabetes with ketonuria (not DKA)

Clinical Pathway: Pediatric Nitrous Oxide Administration
Goals: 1) To Treat pain associated with injuries such as fractures and burns. 2) Prevent/decrease pain associated with painful procedures. 3) To relieve anxiety associated with painful procedures and conditions. 4) Increase patient throughput with reduction of full procedural sedations and recovery time.

Clinical Pathway: Pediatric Prolonged Seizure
Goals: 1) Rapid identification and treatment of pediatric patients with seizure activity lasting longer than 5 minutes or repetitive seizures without resumption of neurological baseline. 3) Create a team-oriented approach to efficient and timely treatment of status epilepticus. 3) Cessation of seizure activity.

Clinical Pathway: Pediatric Sepsis
Goals: 1) Rapid identification and treatment of pediatric patients presenting in septic shock. 2) Create a team-oriented approach to efficient and timely evaluation and work-up. 3) Early and aggressive treatment to stabilize hemodynamic status and reverse shock.

Clinical Pathway: Peds Shunt Failure
Goals: 1) Rapid identification and treatment of children with shunt failure. 2) Team-oriented approach to efficient, timely evaluation and workup. 3? Identification of appropriate disposition.

Clinical Pathway: Suspected Acute Appendicitis (ages 3-18 years)
Goals: 1) Create an efficient, timely, team oriented, standardized approach for the evaluation and work up of children with suspected Appendicitis. 2) Decrease radiation exposure during diagnostic workup.


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OHSU Doernbecher Pediatric Emergency
3181 S.W. Sam Jackson Park Rd.
Portland, OR  97239

503 494-7551