{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:10:53Z","timestamp":1755216653157,"version":"3.43.0"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>To evaluate the impact of a croup clinical pathway (CP) on transfer rates from our urgent cares (UCs).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>We revised our croup CP in November 2022 to recommend giving additional doses of racemic epinephrine (RE) in UC before transferring a patient and using shared decision-making with families on post-RE observation of their child at home or in a clinical setting. We conducted a retrospective cohort study of patients with croup in 3 UCs who received RE in the pre-CP revision (November 2021 to October 2022) and post-CP revision (November 2022 to October 2023) periods. Interrupted time series analysis evaluated trends over time.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>We reviewed encounters of 1575 patients diagnosed with croup in the pre-CP revision and 1530 patients in the post-CP revision. In the pre-CP revision period, 77 patients (4.9%) received RE, and 94 patients (6.1%) received RE in the post-CP revision (<jats:italic toggle=\"yes\">P<\/jats:italic>=0.09). We saw a decrease in patients who received RE that were transferred from 32.5% in the pre-CP revision period (32.5%) to 10.6% in the post-CP revision period (odds ratio, 0.25; 95% CI, 0.11-0.56; <jats:italic toggle=\"yes\">P<\/jats:italic>&lt;0.001). However, Interrupted time series analysis demonstrated downward trends in both time periods with no significant difference over time. Patients discharged within 90 minutes of the last RE increased from 13.5% pre-CP revision to 33.3% post-CP revision (odds ratio, 3.83; 95% CI, 1.46-10.05; <jats:italic toggle=\"yes\">P<\/jats:italic>=0.008). We did not see a change in return visits at 24 or 72 hours.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion:<\/jats:title>\n            <jats:p>Although we saw a downward trend in the percentage of patients with croup transferred after receiving RE in our UCs post-CP revision, we did not see a significant decrease over time. However, this study demonstrates that providing additional RE doses for croup in UC and using shared decision-making with families in the setting for observation did not increase length of stay or return visits.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003396","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T03:00:32Z","timestamp":1744772432000},"page":"635-640","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Using a Clinical Pathway to Safely Reduce Transfers and Admissions for Croup in the Urgent Care"],"prefix":"10.1097","volume":"41","author":[{"given":"Donna R.","family":"Wyly","sequence":"first","affiliation":[{"name":"Division of Urgent Care, Children\u2019s Mercy Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathleen","family":"Berg","sequence":"additional","affiliation":[{"name":"Office of Evidence Based Practice, Children\u2019s Mercy Kansas City"},{"name":"Department of Pediatrics, Children\u2019s Mercy Kansas City"},{"name":"Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Melanson","sequence":"additional","affiliation":[{"name":"Office of Evidence Based Practice, Children\u2019s Mercy Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Gripka","sequence":"additional","affiliation":[{"name":"Office of Evidence Based Practice, Children\u2019s Mercy Kansas City"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Skoglund","sequence":"additional","affiliation":[{"name":"Division of Urgent Care, Children\u2019s Mercy Kansas City"},{"name":"Department of Pediatrics, Children\u2019s Mercy Kansas City"},{"name":"Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria V.","family":"Blanco","sequence":"additional","affiliation":[{"name":"Division of Urgent Care, Children\u2019s Mercy Kansas City"},{"name":"Department of Pediatrics, Children\u2019s Mercy Kansas City"},{"name":"Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5564-3762","authenticated-orcid":false,"given":"Amanda","family":"Nedved","sequence":"additional","affiliation":[{"name":"Division of Urgent Care, Children\u2019s Mercy Kansas City"},{"name":"Department of Pediatrics, Children\u2019s Mercy Kansas City"},{"name":"Department of Pediatrics, University of Missouri-Kansas City, Kansas City, 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