Educational EBM-Based Pathways

Margarita E. Pena, MD, FACEP

Condition-specific protocols are the backbone of a successful Emergency Department Observation Unit (EDOU). Standardized protocols or pathways reduce variability, improve patient flow, and enhance safety while maintaining high-quality outcomes.

Equally important is the integration of observation medicine into emergency medicine residency education. As ED observation units expand nationwide, residents must be trained not only in acute resuscitation but also in risk stratification, longitudinal reassessment, and protocolized care delivery. Educational, evidence-based pathways provide a cognitive scaffold for trainees—linking clinical decision and risk stratification tools, guideline-directed management, and disposition planning in a structured framework.

To this end, I have started to develop evidence-based educational pathways specifically designed for our emergency medicine residents to guide them in appropriate patient selection for the OU vs. inpatient, ED/observation care, and the application of risk stratification tools for common observation conditions. While certain elements reflect institution-specific workflows and resources, the overarching framework is grounded in the literature and adaptable to a variety of practice environments. My hope is that these materials may serve as a practical educational resource for ED clinicians broadly with the flexibility for programs to tailor the pathways to their own institutional structure and patient population. See below for an example of these pathways.  

Here is a link to other pathways with more to be added soon.