Electronic Workflow Quickens Care for Post-Dural Puncture Headache Patients

Post-dural puncture headaches can cause debilitating pain and require rapid evaluation and treatment to relieve symptoms and support recovery.

These headaches can occur after an epidural or other spinal procedure, and while uncommon, they may require evaluation and treatment by an anesthesiologist.

To improve care coordination for these patients, Cleveland Clinic clinical and information technology (IT) teams developed a new electronic workflow that standardizes consultations, streamlines documentation and supports timely treatment decisions. The workflow also closes a documentation gap for patients who did not qualify for or declined the procedure.

“Prior to this workflow, there was no formal consult order or dedicated note for documenting these evaluations,” says Reem Khatib, MD, a Cleveland Clinic anesthesiologist and IT Anesthesia Medical Director. “Emergency medicine physicians wanted a more standardized way to document consultations and coordinate care.”

Centralizing the workflow

The new process supports patients with a suspected post-dural puncture headache who may need an epidural blood patch (EBP) if conservative treatment does not provide relief.

While patients can be evaluated at any Cleveland Clinic emergency department (ED), when treatment is ineffective, they may be transferred to a designated ED location within the health system. At these locations, the ED provider follows the new workflow by placing the EBP consult order and calling the anesthesia control desk or anesthesiologist on call.

To support anesthesia consultations, the project team created an electronic encounter specifically for these patients. The encounter brings relevant patient information into a familiar view and provides direct access to both the consultation and procedure notes. Documentation in the procedure note also supports automated billing, allowing clinicians to complete the necessary work from a single menu instead of navigating through multiple areas of the electronic health record.

“It was very rewarding to create a standardized path that brings the information together and makes it easier for clinicians to do what is necessary for the patient,” explains Dr. Khatib.

The formal documentation also creates a clear record of the anesthesiologist’s evaluation, including situations in which a patient is not considered a candidate for the procedure. Additionally, the workflow enables appropriate billing for consultation work that may not have been captured previously.

Collaboration supports implementation

Developing the workflow required a new technical build and close coordination among clinicians, Epic technical services, anesthesia and emergency medicine analysts, orders and charge teams, trainers and communications partners. The teams tested the order routing, anesthesia notification and charge capture processes before launch.

“This effort required significant collaboration and coordination across several areas,” says Stacy Maples, a Cleveland Clinic systems analyst who helped translate the clinical requirements into the new workflow. “Our goal was to create an efficient, streamlined process that gives anesthesiologists the information and tools they need in one place, without unnecessary steps.”

Clinicians from different sites helped determine what the consultation note should include. Once they reached agreement on the content, Dr. Khatib and Maples worked together to turn those requirements into the technical build.

“Dr. Khatib gathered input from anesthesiologists across multiple services and clinical scenarios,” says Maples. “That foundation helped the IT team better understand the clinical needs, incorporate provider feedback and design a format that supports how clinicians work.”

A model for future workflow improvements

Extensive testing helped the team verify that orders, notifications and charges flowed correctly before clinicians began using the workflow with patients.

For organizations considering a comparable project, the team recommends defining the clinical workflow first and involving stakeholders early.

"Involving people early really helped," says Dr. Khatib. "Before the build began, we worked across the enterprise to gather feedback and align on both the content and the clinical workflow. Having that consensus in place upfront gave the team a clear roadmap and made development much more efficient."

Maples agrees that collaboration across clinical and technical teams was essential. “Reviewing the scenarios before providers evaluated the build was extremely helpful,” she explains. “For other organizations considering a similar workflow, early collaboration among the clinical, technical and provider teams can be highly valuable.”

Ultimately, the shared goal was to make the experience more consistent for patients and simpler for the clinicians caring for them.

“Anything we can do to improve the patient experience is worth it,” Dr. Khatib says. “That’s what makes projects like this meaningful.”