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Results for “Critical Pathways”

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At least 145 records · Page 8Linked to original sources
PubMed1995

Benchmarking critical pathways--a method for achieving best practice.

This article outlines the processes for the development and implementation of critical pathways to achieve best practice by two health organisations funded under the Commonwealth Government's Best Practice in the Health Sector Program. Each organisation is using a slightly different approach to using benchmarking as a tool to ensure best practice is achieved, however, they are similar in that they each demonstrate customer focus and a multidisciplinary, participative change management style.

Australia↗
PubMed2006

Evaluation of analytical studies of critical pathway variances in Japan.

In the last 10 years (1994-2004), the contents of original papers that examined critical pathway variances were analyzed. The results revealed that many research achievements were not applied to practically improving path variances as a result of insufficient coding of variances, and the use of coded data for statistical tests was limited. In order to obtain scientific evidence for evidence-based nursing, it is necessary to actively plan a research design for intentionally analyzing variance.

Humans↗
PubMed1999

Incorporating platelet glycoprotein IIb/IIIa inhibition in critical pathways: unstable angina/non-ST-segment elevation myocardial infarction.

Platelet glycoprotein (GP) IIb/IIIa inhibitors have been shown to be effective in reducing thrombotic events in patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI) and when used as medical therapy in patients with unstable angina/non-ST-segment elevation myocardial infarction (MI). Recent findings include dramatic preventive benefits in the setting of coronary stent deployment and a significant long-term preventive effect on mortality. The benefits of GP IIb/IIIa receptor inhibition suggest the utility of adopting routine use of these agents in critical pathways of unstable angina/non-ST-segment elevation MI and PCI. Because cost constraints may limit use of these agents, however, targeting treatment based on patient risk assessment may be warranted.

Abciximab↗
PubMed2006

A critical pathway for patients with acute chest pain and low risk for short-term adverse cardiac events: role of outpatient stress testing.

STUDY OBJECTIVE: We evaluate the safety and feasibility of a critical care pathway protocol in which patients with acute chest pain who are low risk for coronary artery disease and short-term adverse cardiac outcomes receive outpatient stress testing within 72 hours of an emergency department (ED) visit. METHODS: We performed an observational study of an ED-based chest pain critical pathway in an urban, community hospital in 979 consecutive patients. Patients enrolled in the protocol were observed in the ED before receiving 72-hour outpatient stress testing. The pathway was primarily analyzed for rates of death or myocardial infarction in the 6 months after ED discharge and outpatient stress testing. Secondary outcome measures included need for coronary intervention at initial stress testing and within 6 months after discharge, subsequent ED visits for chest pain, and subsequent hospitalization. RESULTS: Of 871 stress-tested patients aged 40 years or older, who had low risk for coronary artery disease and short-term adverse cardiac events, and had 6-month follow-up, 18 (2%) required coronary intervention, 1 (0.1%) had a myocardial infarction within 1 month, 2 (0.2%) had a myocardial infarction within 6 months, 6 (0.7%) had normal stress test results after discharge but required cardiac catheterization within 6 months, and 5 (0.6%) returned to the ED within 6 months for ongoing chest pain. Hospital admission rates decreased significantly from 31.2% to 26.1% after initiation of the protocol (P<.001). CONCLUSION: For patients with chest pain and low risk for short-term cardiac events, outpatient stress testing is feasible, safe, and associated with decreased hospital admission rates. With an evidence-based protocol, physicians efficiently identify patients at low risk for clinically significant coronary artery disease and short-term adverse cardiac outcomes.

Acute Disease↗
PubMedDate not supplied

Critical pathways: design, implementation, and evaluation.

As David M. Eddy, M.D., Ph.D., Senior Advisor for Health Policy and Management to Southern California Kaiser Permanente, discusses in his excellent book, Clinical Decision Making: From Theory to Practice (1), we are now in a time where we must rethink what we are doing and how we are doing it. Substantial variations among physicians in almost every aspect of the diagnostic process have been documented repeatedly, and these variations appear to cause patients to be treated differently. Eddy says these variations are not the fault of physicians or anyone else because of the complexity of the medical decision process. Nonetheless, the cost and quality of health care have suffered as a result. Numerous articles and individuals such as Jay McDonald, M.D., Professor and Chair of the Department of Pathology at the University at the University of Alabama at Birmingham Medical Center, also have highlighted these variables in practice patterns and their consequences (2). Dr. Eddy, Dr. McDonald, Michael G. Bissell, M.D., Ph.D., Director, Clinical Pathology, Allegheny General Hospital, Pittsburgh, Pennsylvania, and other leaders in the field have stressed the need for more standardization of health care; clinical decisions concerning diagnostic testing and therapeutic choices must be based on scientific evidence that demonstrates the practice being used is truly effective (1-6). This evidence, as well as other parameters discussed below, are known as outcomes. As expressed by Dr. McDonald, "there is a transition that is going on from doing what seems best to doing what one knows is best" (2). Practice guidelines and critical pathways now are seen by many as one solution to providing more standardization of health care and to meeting the demands of the rapidly changing medical environment for simultaneously increasing the quality of care while decreasing the costs.

Critical Pathways↗
PubMedDate not supplied

Enhancing staff skill. Developing critical pathways at a community hospital.

Clinical pathways are an essential tool in implementing case management. The authors, in this article, describe how one institution developed and implemented critical pathways. The result was enhanced staff skill in physical assessment, patient/family teaching, and communication with physicians.

Clinical Competence↗
PubMed2006

A critical pathway for meeting the needs of families of patients with severe traumatic brain injury.

Family members of patients recovering from severe traumatic brain injuries have needs that are best met through early assessment and proactive intervention. A critical pathway addressing the needs of families during the acute and postacute phases of hospitalization was developed and implemented in the neuroscience intensive care and step-down units of a university hospital. A team of 10 neurosurgical nurses used and evaluated the program.

Brain Injuries↗
PubMed1994

Critical pathways: an integrated documentation tool.

A multipurpose six-page, three-fold flow sheet improves patient outcomes, meets JCAHO standards and facilitates easy tracking of a patient's progress. The flow sheet is divided into nursing process, expected patient outcomes, critical pathway and variance report. Outcomes management is an effective process to control costs and improve patient outcomes.

Documentation↗
PubMed2003

Critical pathways for the management of preeclampsia and severe preeclampsia in institutionalised health care settings.

BACKGROUND: Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs) designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. METHODS: Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a) Definition of the conceptual framework; b) Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c) Structural development. RESULTS: The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. CONCLUSION: Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and remodelling according to each system's demands. Additionally, the CPs need to be tested in large-scale, multi-level studies in order to thoroughly examine and evaluate their efficacy and effectiveness.

Journal Article↗
PubMed2001

A critical pathway for electronic medical record selection.

Electronic medical records (EMRs) are increasingly becoming a necessary tool in health care. Given their potential to influence every aspect of health care, there has been surprisingly little rigorous research applied to this important piece of emerging health technology. An initial phase of the COMPETE study, which is examining the impact of EMRs on efficiency, quality of care and privacy concerns, involved a rigorous "critical pathway" approach to EMR selection for the study. A multidisciplinary team with clinical, technical and research expertise led an 8-stage evaluation process with direct input from user physicians at each stage. An iterative sequence of review of EMR specifications and features, live product demonstrations, site visits, and negotiations with vendors led to a progressive narrowing of the field of eligible EMR systems. Final scoring was based on 3 main themes of clinical usability, data quality and support/vendor issues. We believe that a rigorous, multidisciplinary process such as this is required to maximize success of any EMR implementation project.

Humans↗
PubMedDate not supplied

Critical pathways: the next generation of outcomes tracking.

In summary, for each critical path you should have financial, quality, variance analysis, health-related quality of life and patient satisfaction outcome measures that should be reported as a package in a frequency established by the organization. These measures must complement the overall critical path program goals and objectives. The data must also be provided to the critical path teams to analyze and define where there may be opportunities for improvement. This puts the data analysis and responsibility of care processes into the hands of the clinicians where it belongs and not with administration. Administration provides the vehicles for the data; the clinicians provide the analysis.

Case Management↗