169 - Understanding the Utility of Clinical Pathway Components: Trainee Use and Perspectives

Publication Number: 3163.169

Amanda Higgins, Boston Children's Hospital, Boston, MA, United States; Jason E. Miller, Boston Children's Hospital, Boston, MA, United States; Michaela E. Nolan, Boston Children's Hospital, Boston, MA, United States; Dionne Graham, Boston Children's Hospital, Boston, MA, United States; Kristen Kelly, Boston Children's Hospital, Wellesley, MA, United States; Chandler E. Moore, Boston Children's Hospital, Boston, MA, United States; Netta Cudkevich, Boston Children's Hospital, Boston, MA, United States; Gabriel Paris, Boston Children's Hospital, West Roxbury, MA, United States; Sara Toomey, Boston Children's Hospital, Cambridge, MA, United States; Kristen T. Leeman, Boston Children's Hospital, Winchester, MA, United States

Background: Clinical Pathways (CPs) are valuable tools to guide evidence-based medical decision-making and can help standardize care, promote best practice, reduce cognitive load, improve efficiency, and enhance interdisciplinary teamwork. For the medical trainee user, CPs can also offer educational support, improve time management, and aid to optimize care through standardization of approach. In our large academic medical center, trainees are high frequency users of the internal CP library.

Objective: To describe trainee use of CPs and identify opportunities to optimize these care algorithms for trainee users.

Design/Methods: A multidisciplinary team collected data from the Boston Children's Hospital (BCH) Clinical Pathway Program to determine trainee usage during fiscal year 2025 (FY25). Pathway click rates were analyzed to determine the most commonly accessed pathways by trainees. The project team developed a survey and distributed it to all BCH trainees to analyze current CP use, highest yield CP components, and opportunities to optimize CPs. The team distributed the survey through a REDCap database to all trainees via email with anonymous responses. Data was analyzed using SPSS statistical software.

Results: Over FY25, self-designated "Resident/Fellow" users accessed CPs an average of 4,080 times per month (40.5% of CP access clicks). A total of 844 unique "Resident/Fellow" accounts clicked on CPs in FY25. The top 10 most accessed pathways had a range of 949-1970 total clicks (See Table 1). Survey data included 79 responses (RR = 12%) from ~ 50% residents and ~ 50% fellows in 33 different BCH training programs. Respondents reported 84% used CPs and 74% accessed CPs more than once per week. Eighteen percent had high rates of access with report of > 5 times per week. A higher percentage of trainees "agree/strongly agree" that CPs are useful for familiar/frequent (92%, 95% CI: 83%-98%) compared to unfamiliar/infrequent (75%, 95% CI: 63%-85%) conditions. The components of clinical pathways reported to be most "Helpful/Very Helpful" in trainee practice included diagnostic guidance (94%) and medication management (94%) with the least helpful component being local external resource connections (27%) (See Figure 1). Barriers to use included login steps/issues and difficulty with searchability.

Conclusion(s): Trainees frequently access CPs to help guide patient care and as an educational resource. Interestingly, frequent/familiar condition CPs are the most useful and repeatedly accessed. Trainee reported CP component assessment can guide and optimize future CP development.

Table 1
Top 10 accessed clinical pathways by Residents/Trainees at large academic center in FY2025

Figure 1
Trainee Reported Utility of Clinical Pathway Components