Dizziness Standardization Pathway case study

Value-Based Care Case Studies

Abstract

The Dizziness Standardization Pathway is a multidisciplinary clinical care model designed to improve the assessment and management of dizzy patients in the emergency department (ED). Developed collaboratively by neurologists and emergency physicians at Brigham and Women’s Hospital, the pathway provides standardized guidance on when to perform imaging and when to involve neurology, either emergently or via outpatient referral. This model promotes patient safety, reduces unnecessary imaging and consultations, and enhances care efficiency by identifying high-risk patients and ensuring timely, appropriate intervention. Implemented for over eight years, the pathway supports improved clinical outcomes, cost savings, and resource optimization. While adoption required significant time for consensus-building and provider education, the model is now associated with high provider satisfaction and exemplifies the benefits of multidisciplinary collaboration in care standardization.

Introduction

This clinical care model establishes a standardized pathway for assessing and evaluating dizzy patients in the emergency department (ED), developed collaboratively by neurologists and emergency physicians. It guides ED physicians on appropriate imaging and when to consult a neurologist.

The AAN’s Care Delivery Subcommittee, under the guidance of the Medical Economics and Practice Committee, continues to seek out and to better understand different and complex care delivery models, their core functions, and features, as well as the professional and personal advantages and disadvantages of these models for neurologists and neurology care teams. The subcommittee’s own Mary Angela O’Neal, MD, FAAN, from Brigham and Women’s Hospital, shared her insights into a multidisciplinary care model, Dizziness Standardization Pathway. Responses below represent the individual experiences of the contributors and are not the official opinion of the AAN.

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Value proposition

Value proposition to the patient

  • Improved patient outcomes
  • Decreased time to specialty treatment
  • Efficient triaging and resource allocation

Value proposition to the provider

  • Increased communication and collaboration among care team members
  • Standardization of best practices
  • Efficient implementation

Value proposition to the health system

  • Increased cost savings and resource efficiency
  • Increased opportunity for improved outcomes and patient satisfaction

The care model

The emergency department (ED) at Brigham and Women’s Hospital in Boston, MA, utilizes the Dizziness Standardization Pathway model. The model was developed by both neurologists and emergency physicians to standardize access and evaluate dizzy patients presenting to the ED. The multidisciplinary model includes neurologists, emergency physicians, radiologists, and consultative services. The pathway is intended to recommend imaging and appropriateness of when and if a neurologist should be consulted either emergently or when an outpatient referral is needed. The model supports safety, lower costs, and better patient outcomes by triaging patients to ensure appropriate consultations and imaging are secured, all while not using unnecessary resources. Furthermore, it identifies high-risk patients to make certain they are treated appropriately.

How it works

  1. Step 1: Patient presents to the emergency department with dizziness.
  2. Step 2: Emergency physicians implement the dizziness pathway to best recommend practices developed by neurologists.
  3. Step 3: Patient receives care at emergency department or neurology is consulted, or outpatient referral is provided.

The emergency department leadership is responsible for the utilization and outcome reporting to ensure improved outcomes and care efficiency.

The benefits of this model are the support of safety, lower costs, and better patient outcomes by triaging patients to get the necessary consultation and imaging while also not using unnecessary resources. Further, it works to identify high-risk patients to ensure they are receiving the appropriate and timely treatment they require. The standardization pathway has been implemented for eight years and continues to meet the challenges of a changing health care system.

The key challenge of this model was the development and implementation of the pathway, which required significant time for content agreement and education on appropriateness and certain neurologic exams.

Although the dizziness pathway is not a required course of action in the area, it is a guide of recommendations developed and referenced by experts as opposed to what an individual physician may decide.

The provider experience

Providers, including ED physicians and neurologists, associate the pathway with high satisfaction as they find the collaboration and communication among specialties to standardize best practices and ensure improved patient outcomes. Brigham and Women’s Hospital benefits greatly from this pathway due to the increased cost savings and resource efficiencies.