Critical pathways : a review. Committee on Acute Cardiac Care, Council on Clinical Cardiology, American Heart Association.
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Cardiovascular Diseases↗
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Use of severity adjusted comparative systems in the development of critical pathways.
This paper has been prepared to present how South Shore Hospital has successfully used computerized applications to provide the highest quality patient care in the most cost-efficient manner.
Critical Pathways↗
Critical pathways: an efficient way to manage care.
Liz Herring argues that care pathways provide a change in the traditional approach to planning and documenting care. She suggests that they provide opportunities for the more efficient use of nursing time and resources.
Critical Pathways↗
Three alternative methods of developing critical pathways cost and benefits.
Three common methods of determining optimum pathways and their attendant cost and time requirements will be evaluated. Popular methods used for the development and adaptation of pathways are the use of published guidelines, the creation of pathways within an existing health care system and the use of an automated tool. The cost and time required for each of these methods vary tremendously.
Cost-Benefit Analysis↗
Managed care and critical pathway development: the joint replacement experience.
This article examines the economic, social, ethical, and political issues affecting total joint replacement patients in a managed care environment. Using general systems theory as a framework, it examines the interrelated historical events that have shaped the development of both joint replacement procedures and managed care, and discusses the extent to which these two phenomena have been mutually influential. Specifically, the article examines the initial development, implementation, and continuing evolution of clinical pathways as an easily identified and relatively discrete manifestation of managed care for the joint replacement population. While the overall impact of managed care is beyond the scope of this presentation, it is hoped that a focus on the practical application of clinical pathways to joint replacement will allow some general principles to emerge that may be useful for both patients and practitioners operating in other aspects of the managed care environment.
Arthroplasty, Replacement↗
Pediatric simple open heart surgery critical pathway.
In 1997, administrators discovered that DRG 108 (other major cardiothoracic procedures), which includes many of the surgical repairs for congenital heart disease, was one of the biggest money losers for Vanderbilt Children's Hospital, resulting in a loss of approximately $1 million dollars per year. Time for action.
Child↗
Application of the critical pathway and integrated case teaching method to nursing orientation.
BACKGROUND: Nursing staff development programs must be responsive to current changes in healthcare. New nursing staff must be prepared to manage continuous change and to function competently in clinical practice. METHOD: The orientation pathway, based on a case management model, is used as a structure for the orientation phase of staff development. The integrated case is incorporated as a teaching strategy in orientation. The integrated case method is based on discussion and analysis of patient situations with emphasis on role modeling and integration of theory and skill. RESULTS: The orientation pathway and integrated case teaching method provide a useful framework for orientation of new staff. Educators, preceptors and orientees find the structure provided by the orientation pathway very useful. CONCLUSION: Orientation that is developed, implemented and evaluated based on a case management model with the use of an orientation pathway and incorporation of an integrated case teaching method provides a standardized structure for orientation of new staff. This approach is designed for the adult learner, promotes conceptual reasoning, and encourages the social and contextual basis for continued learning.
Adult↗
Obtaining consistent quality patient care for the trauma patient by using a critical pathway.
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Critical Care↗
Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Chapter 17. Critical pathway for the treatment of established intracranial hypertension in pediatric traumatic brain injury.
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Acute Disease↗
Application of critical pathways in the maternity nursing orientation process.
The creation of an individualized, systematic, and comprehensive clinical orientation is essential for the newly hired nurse, the nurse preceptor, and nursing managers. The development, implementation, and use of "orientation pathways" provides a framework that will produce an individualized orientation based on clinical experience, focus on specific criteria for patient care and unit duties, ensure completion of skill competency criteria within a specified time frame, and assist with identification of problems and/or weaknesses the nurse orientee may be experiencing.
Critical Pathways↗
Experience with levofloxacin in a critical pathway for the treatment of community-acquired pneumonia.
Community-acquired pneumonia (CAP) is associated with considerable morbidity and mortality in both developed and developing countries. Despite research into the optimal management of this condition, there remains great variation in how patients with CAP are treated. A study was performed to assess the results of CAP treatment using a clinical pathway that incorporated admission guidelines, standard treatment orders with oral levofloxacin or cefuroxime axetil plus azithromycin, and an algorithm for oxygen therapy and discharge. The study involved seven centers enrolling 7,734 patients, 55% of whom were treated as outpatients and the remainder were admitted. Overall mortality was 8%, and increasing severity of illness, as assessed by pneumonia severity risk score, was associated with early mortality (within five days of admission) and late mortality (five or more days following admission). The use of the clinical pathway was associated with a reduction in early mortality. The use of levofloxacin alone or with cefuroxime axetil plus azithromycin was associated with decreased mortality compared with the use of other antibiotics.
Adolescent↗
[Acute appendicitis. Usefulness of a evidence-based critical pathway].
OBJECTIVE: To determine the effects of an evidence-based clinical pathway for acute appendicitis in paediatric patients at a tertiary hospital. METHODS: We studied 229 patients with an age range from 3 to 14 years, with a pathological diagnosis of acute appendicitis divided in two groups. A prospective, experimental clinical pathway group of children (n = 114), (June 1999-January 2001) was compared with a historical control prepathway group of patients treated by conventional means in the previous years, (n = 115), (December 1997-May 1999). Age, gender, type of appendicitis (uncomplicated/complicated), length of hospitalisation, number of antibiotics doses supplied and rates of complications, were compared between pathway and and control patients. RESULTS: There were no differences in age (p = 0.61), gender (p = 0.73), either the number of complicated/uncomplicated appendicitis (p = 0.91) between the two groups. The average duration of hospitalisation was significantly shortened in pathway group (4.34 versus 5.33 days) (p = 0.000049) and the number of antibiotics doses were reduced from 16.13 to 11.17 doses (p = 0.000000). The number of major complications was lower in the pathway group than in the control group (6 and 16 respectively) but there was no significative difference (p = 0.09). CONCLUSIONS: Clinical pathway is an efficient and safe tool for acute appendicitis because decrease the length of hospitalisation and the number of antibiotics doses supplied, while maintaining quality of care.
Acute Disease↗
Clinical utility of the Food and Drug Administration Electrocardiogram Warehouse: a paradigm for the critical pathway initiative.
Although there are rising public expectations about the prospects for new therapies based on advances in biomedical discoveries, the rate of new product submissions to the Food and Drug Administration (FDA) has not been increasing. Alarmingly, over the past 6 years, there has been a 30% decline in submissions. The reasons for this are multifactorial and include new science not at its full potential, mergers/business arrangements have decreased candidates, chronic disease is harder to study, the failure rate has not improved, and rapidly escalating costs and complexity. Notably, societal investment in research and development to improve the drug approval process has been lacking in contrast to the large investments, both private and public, in basic research and specific product advances. The Critical Path Initiative has been developed by the FDA to combat many of these issues. This initiative is designed to be collaborative between government, academic, industry, and patient groups. The partnership is designed to expand product opportunities by sharing existing knowledge and data, allowing the development of enabling standards, to improve drug development and approval. A central tenant of Critical Path is a focus on the evaluative science of the drug approval process, including both efficacy and safety measures. The FDA Electrocardiogram Warehouse is 1 example where a government resource could be used by a confluence of groups to improve the science surrounding important components of the drug approval process such as cardiac safety evaluation.
Critical Pathways↗
Evidence-based medicine, critical pathways, practice guidelines, and managed care. Reflections on the prevention and care of stroke.
Because managed care plans are exerting enormous pressure to reduce the cost of medical care, neurologists need to enhance their skills at identifying appropriate, high-quality, and cost-effective care for patients with neurological disorders. A variety of health services research methods are available that foster evidence-based decisions and de-emphasize intuition in decision making. Despite imperfect data and a lack of familiarity with some of these methods, we have found them useful in developing guidelines and pathways for the prevention and management of stroke. Neurologists should become more familiar with the pragmatic benefits, limitations, and obstacles that hinder acceptance and implementation of these approaches. If we wish to continue to influence the medical decision process, we must focus on the provision of quality neurological care and not on the managed care plan.
Aged↗
[Quality management: internal guidelines and critical pathways for patients].
BACKGROUND: The construction and implementation of "Practice Guidelines" was one of the most important developments in American medicine of the last 15 years. There is ongoing controversy about the effectiveness of these guidelines to get introduced into practice. It has been proved, however, that guidelines developed by care organizations themselves, will show a higher effectiveness and acceptance and will achieve more positive results (Internal Guidelines, "Locally Owned" Standards). "Mipp": Internal Guidelines are also the starting point for the patient pathways of the model of integrated patient pathways "mipp", developed at the Kantonsspital Aarau in the last 7 years. The model is presented with its main features: Construction and Implementation of Pathways, Path-Controlling, Path-Benchmarking and Path-Visualization. "Mipp" Pathways share with Clinical Pathways the interdisciplinary perspectives for an efficient quality management. The description of processes is combined with an integrated calculation of costs, which is the basis of standard cost accounting and even activity based-costing. CONCLUSION: In the field of upcoming prospective payment systems (PPS) like ARDRG, APDRG etc. it is of utmost importance for care organizations to have a clear view regarding the treatment processes and the possibilities of their improvement.
Benchmarking↗
Critical pathways in anterior cranial base surgery.
New advances in anterior cranial base surgery have dictated the need for a comprehensive, multidisciplinary approach in the treatment of lesions of this area, necessitating multiple modes of diagnostic and surgical techniques. Traditional consideration of the complex problems presented by neoplastic involvement of the anterior cranial base predicated on isolated syndrome analysis is no longer sufficient to adequately assess tumor pathology. To address these complex problems, we discuss a method of localization of pathology based on anatomic structure and function as well as the corresponding surgical approach to the anterior cranial base.
Cavernous Sinus↗
Transformational leadership and the hospice R.N. case manager: a new critical pathway.
This article asserts that in light of changing conditions in the healthcare environment, transformational leadership is the most appropriate leadership style for the hospice registered nurse case manager. The author defines transformational leadership and, tracing from early leadership theories, demonstrates how the transformational-transactional leadership paradigm emerged from preceding leadership theories. The components of transformational leadership--transformational behavior and transformational characteristics--are linked to hospice theory and hospice-specific nursing practices. The expanding role of the hospice R.N. case manager is addressed in light of transformational leadership and culture building. Specific actions are proposed in the arenas of research, education, and community, corporate, and legislative involvement.
Case Management↗
Critical pathways in analyzing breast calcifications.
Screening-detected microcalcifications are responsible for more benign biopsy results than any other mammographic lesion. The management of these lesions comes at a large cost in terms of morbidity and dollars spent. Both costs and morbidity could be reduced by decreasing the number of surgical biopsies. This could be accomplished by increasing the positive biopsy rate and by substituting core needle biopsy for surgical biopsy when appropriate. To increase the positive biopsy rate, we need to improve the preoperative evaluation of microcalcifications. A scheme is presented for the mammographic evaluation of these microcalcifications and for the appropriate use of core biopsy in the management of these lesions.
Biopsy↗