Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Critical Pathways”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,621 records · Page 90Linked to original sources
PubMed2000

Carotid endarterectomy: creating the pathway to 1-day stay.

Use of a collaborative team approach to design a care pathway and standing orders for carotid endarterectomy patients achieved the project's goals. Variation, LOS, and resource consumption were decreased while quality of care and patients' satisfaction levels were maintained. Education of patients, patients' families, and staff members increased. Coordination between caregivers increased. The consistent concurrent database provided a feedback loop for continued change and for setting the target. Essential to the success was sponsorship from key leadership via the hospital's steering committee. The diverse membership of key associates on the CQI team helped to create an excellent revised carotid endarterectomy process and ensured full implementation. This membership of the CQI team was essential to comprehensive education and implementation. The step-by-step implementation kept the project moving forward. Creating a care pathway and changing practice require collaboration between nurses, doctors, and administrators. Creativity and systematic, thorough steps are what move a practice change from idea to inception.

Cooperative Behavior↗
PubMed2002

Beneficial impact of a clinical care pathway in patients with testicular cancer undergoing retroperitoneal lymph node dissection.

PURPOSE: Since 1997, we have used a clinical collaborative care pathway for patients undergoing retroperitoneal lymph node dissection. We examined its impact on perioperative care and outcome. MATERIALS AND METHODS: We examined the records of all patients with germ cell carcinoma who underwent retroperitoneal lymph node dissection from July 1990 to July 2001. Variables examined included clinical/pathological stage, hospital stay, postoperative care and the complication rate. RESULTS: A total of 118 patients underwent retroperitoneal lymph node dissection for germ cell carcinoma during this period, including 46 (39%) before pathway implementation in 1997 and 72 patients (61%) after pathway implementation. Of the 118 patients 40 (34%) underwent the procedure after chemotherapy. This rate remained fairly constant in the period before and after pathway initiation (31% and 36%, respectively). After pathway implementation fewer patients received a nasogastric tube (94% versus 5%, p <0.001) and had complications (26% versus 16%, p = 0.036). Mean hospital stay decreased after pathway implementation in all primary and post-chemotherapy retroperitoneal lymph node dissection cases (4.2 versus 6.4 days, p <0.005). Although patients who underwent the procedure after chemotherapy were more likely to have complications than those who underwent a primary procedure, the difference was not statistically significant (p = 0.09). CONCLUSIONS: Our collaborative clinical care pathway safely and efficiently outlines routine postoperative care and significantly decreased hospital stay.

Adult↗
PubMed2002

The mastectomy clinical pathway: what has it achieved?

INTRODUCTION: The mastectomy clinical pathway was developed to optimise the clinical care and cost management of breast cancer patients. The aim of this study was to prospectively assess the effect of the mastectomy pathway at the National University Hospital, Singapore over a 7-month period. MATERIALS AND METHODS: A prospective study was carried out on all breast cancer patients admitted for elective mastectomy between March and October 2001. As surrogates of optimised cost and care management, the length of stay and hospital costs, as well as the incidence of complications and unscheduled readmissions, were analysed. Non-pathway mastectomy patients treated from March to October 2000 were used as controls. A total of 83 patients who underwent mastectomy formed the pathway group, while 69 non-pathway patients acted as controls. RESULTS: Compared to controls, the mean length of hospital stay decreased significantly from 4.91 days to 4.10 days (P = 0.018) and the mean cost per case decreased significantly from $5,050 to $4,406 (P = 0.014) for those in the pathway group. There were no significant differences in the complications and unscheduled hospital readmission rates between the two groups (P > 0.05). CONCLUSION: The implementation of mastectomy clinical pathway has improved consistency in patient's treatment, the quality of patient outcome, and has reduced the costs of care and length of hospital stay. In addition, variance analysis of the mastectomy pathway has shown to be valuable for problem identification to improve patient care.

Adult↗
PubMedDate not supplied

Improving practice with the Liverpool Care Pathway.

The Liverpool Care Pathway for the Dying Patient (LCP) is an evidence-based document that acts as a guide for health care professionals when caring for patients in the last days of their lives.

Critical Pathways↗
PubMed2006

Effects of counseling and implementation of clinical pathway on diabetic patients hospitalized with hypoglycemia.

OBJECTIVES: A prospective randomized controlled study was conducted to examine the effects of counseling and implementation of clinical pathway on type 2 diabetic patients hospitalized with hypoglycemia. MATERIAL AND METHOD: Thirty- three cases received counseling and clinical pathway for treatment of hypoglycemia (study group) and another 32 cases received conventional treatment for hypoglycemia (control group) in Taksin Hospital between July and December 2005. RESULTS: Both groups have similar age, sex, and mean serum glucose on admission. There were also no differences between the two groups in terms of number of patients with chronic diabetic complications, acute concurrent illness and pattern of hypoglycemic drugs used for treatment. Average length of hospital stay of the study group was significantly lower than that of the control group (3.94 +/- 1.03 vs 6.38 +/- 4.05; p = 0.0005). There were also a significant decrease in the mean number of capillary blood glucose tests performed in the study group compared to the control group (10.03 +/- 5.04 vs 12.34 +/- 5.96; p = 0.048). Subsequent readmissions with recurrent hypoglycemia at 1 and 3 months interval after being discharged from the hospital decreased significantly in the study group (6.06 % vs 34.38 %; p = 0.036). While there was considerable reduction in mean medical cost in the study group, it did not reached a statistically significant difference when compared with the control group (2,743.58 +/- 1,473.04 vs 3,687 +/- 3,110.82; p = 0.06). CONCLUSION: Counseling and implementation of clinical pathway on type 2 diabetic patients hospitalized with hypoglycemia can reduce the length of hospital stay and decrease readmission rates of recurrent hypoglycemia. This results in considerable health and economic benefits.

Counseling↗
PubMedDate not supplied

Benchmarking: a case report.

In mid 1993, administrators and physicians at Bristol Medical Center teams up with HCIA to perform clinical pathway analysis on five diagnosis related groups. The major goal of this project was to establish a partnership between the hospital administration and the medical staff to meet or beat existing benchmarks.

Critical Pathways↗
PubMedDate not supplied

A continence pathway for acute stroke care.

Clare Gordon and Catherine Weller describe the development of an acute phase continence assessment tool that is to be completed within 24 hours of a patient's admission following a stroke.

Acute Disease↗
PubMed2003

The critical cis-acting element required for IMD2 feedback regulation by GDP is a TATA box located 202 nucleotides upstream of the transcription start site.

Guanylic nucleotides are essential cellular players, and the critical enzyme in their tightly regulated synthesis in Saccharomyces cerevisiae is encoded by the IMD2 gene. The transcription of IMD2 is subject to general repression by nutrient limitation through the cis nutrient-sensing element. It is also subject to specific feedback regulation by the end products of the guanylic nucleotide synthesis pathway. The critical cis element for this latter mechanism is the guanine response element (GRE), a TATAATA sequence which is located 202 nucleotides upstream of the transcription initiation site and which functions as the IMD2 TATA box. We show that the GRE functions in conjunction with a 52-nucleotide stretch near the transcription start site. This very unusual promoter structure ensures low, basal expression of IMD2 and the recruitment of TFIID to the GRE in response to guanylic nucleotide limitation.

Base Sequence↗
PubMed1999

Development and implementation of a clinical pathway for patients undergoing total laryngectomy: impact on cost and quality of care.

BACKGROUND: The current health care climate demands the provision of quality patient care in a cost-effective manner. Clinical pathways define the essential components of care that are provided to patients with a specific diagnosis to achieve a desired outcome within a predetermined period. Development and implementation of clinical pathways streamline the provision of quality care in the most cost-effective manner. OBJECTIVES: To develop a clinical pathway for patients undergoing total laryngectomy and to evaluate its impact on the cost and quality of care provided to these patients. SETTING: A tertiary care academic medical center. PATIENTS AND METHODS: A total of 45 patients were included in the study. The clinical pathway was implemented for 15 patients, while the other 30 patients were treated without the implementation of the pathway guidelines. MAIN OUTCOME MEASURES: Length of hospital stay, readmission rate, and hospital variable costs. RESULTS: The clinical pathway affected all cost outcome measures. Length of stay decreased by 2.4 days (29%; P=.001), and the average hospital variable cost decreased from $3992 to $3419 per case. This represents a 14.4% reduction in cost associated with pathway implementation (P=.02). The standardization of care eliminated unnecessary variation and repetition in resource usage, resulting in overall cost reduction. Pathway implementation resulted in a lower readmission rate (7% [1/15]) than that of patients treated prior to protocol implementation (23% [7/30]). CONCLUSION: Implementing a carefully developed clinical pathway may reduce cost without compromising the quality of care for patients undergoing total laryngectomy.

Cost Control↗
PubMed2003

Does a clinical pathway improve the quality of care for sickle cell anemia?

BACKGROUND: Clinical pathways are often implemented to improve care, yet their effect on quality of care and outcomes is often not evaluated. The Johns Hopkins Children's Center instituted a clinical pathway in early 1996 to improve the care for pediatric sickle cell vaso-occlusive crisis (VOC) and used a retrospective before-after study to describe how quality of care and outcomes changed after introduction of the pathway. RESULTS: Physicians used the pathway in 43% of eligible admissions, with use decreasing over time. Patients on the pathway were more likely to receive each of its required elements than those not on the pathway (odds ratios [OR] 1.15-2.49). After pathway implementation, even patients not on the pathway were more likely to receive incentive spirometry than those admitted before pathway availability (OR 1.40). Pathway use was associated with longer length of stay (LOS) and time to oral pain medication, while readmission rates did not change. DISCUSSION: Use of a clinical pathway improved quality of care by increasing compliance with specific care elements, with mixed results on outcomes. Pathways may improve care for all patients, including nonpathway-treated patients, by influencing underlying practice patterns. Quality improvement committees must regularly monitor outcomes after pathway implementation to evaluate the need for pathway reinforcement and refinement.

Adolescent↗
PubMed2004

Effects of introducing an integrated care pathway in an acute stroke unit.

BACKGROUND AND PURPOSE: integrated care pathways are often implemented to guide acute stroke therapy and improve organisation of care, but there is not sufficient evidence to support their routine use. We sought to evaluate the effects of introducing an integrated care pathway for acute stroke. METHODS: we performed a before-and-after study. The 'before' (control) group comprised 154 consecutive stroke patients admitted to the acute stroke unit over a 9-month period. The 'after' (intervention) group comprised 197 consecutive patients admitted to the same unit over a 9-month period in the year after the introduction of the integrated care pathway. Effectiveness was assessed with a variety of measures: quality of documentation; process of care; occurrence of complications; death and discharge destination. Results were adjusted for case mix using a validated model. RESULTS: the baseline characteristics of the two groups were similar, although there were more total anterior circulation strokes (29% versus 18%, P = 0.005) and fewer partial anterior circulation strokes (30% versus 42% P = 0.04) in the intervention group. In the intervention group, we found that urinary tract infections were significantly less frequent (OR 0.37, CI 0.15-10.91) and the quality of several aspects of care (e.g. CT scanning < 48 hours) and documentation were significantly better. However, there were no significant differences in deaths, discharge destination, or length of stay between the two groups. CONCLUSION: this before-and-after study has provided further evidence that introducing an integrated care pathway for acute stroke may improve the quality of documentation and process of care, and reduce the risk of certain post-stroke complications.

Acute Disease↗
PubMedDate not supplied

Acute surgical wound care. 4: The importance of documentation.

This article, the last in a series of four, discusses the importance of documenting wound care. Studies have shown that nurses do not document wound care as often, or as accurately, as they should in order to comply with the UKCC's (1998) Guidelines for Records and Record Keeping. Although some wound assessment charts have been published and are in use, there is still concern about the validity or reliability of some of these charts. Studies show that further research is necessary in order to validate the charts that are currently in use. An increase in litigation has placed more emphasis on accurate record keeping which shows, in detail, the wound care that is given to each patient. Patients also want to be more informed about their treatment, and this can be done through the use of clinical pathways or multidisciplinary documents. This article also discusses the factors that have to be considered when putting a wound care chart together and gives some examples of existing charts.

Acute Disease↗
PubMed2003

Evaluating the Navigate Care Model: clinical palliative care pathways based on anticipated care outcomes.

The Navigate Care Model (NCM) specifies clinical pathway assignments for hospice patients based on the anticipated outcomes of death, discharge home, or discharge into residential care. This study, set in a freestanding, inpatient hospice, evaluated the effects of NCM implementation on 338 patients, 154 family members and the organization, including 49 staff. Accuracy of pathway assignment on admission was also assessed. The results indicate that patients' symptoms were managed as well or better than previously, as compared with 1998 data. Discharged patients reported being highly satisfied with care and there were fewer readmissions. Families reported greater satisfaction with care than those surveyed previously, as compared with 1999 data. Staff reported initial negative effects but elected to retain a refined version of the model after the study. Pathway assignments on admission were correct 64% of the time, 92% correct when assignment was for terminal care. Clinical pathways based upon the expected outcomes of death or discharge appear to offer benefits for patients and families.

Adult↗
PubMed1999

Push past pathway limits to cut resource use.

With lengths of stay now beginning to rebound, some experts claim that clinical pathways must be used primarily to standardize resource utilization and foster a team approach in coordinating patient care. While length of stay remains an important variable to measure, pathways don't have to be structured using a traditional time line. Other options include using a flowchart approach and supplementing traditional pathways with perioperative pathways and algorithms. To effectively identify and decrease unnecessary resource use, you must analyze what physicians and other clinicians are really using and attempt to standardize it, experts say.

Arthroplasty, Replacement↗
PubMed2001

Computerised clinical pathway as process quality improvement tool.

Experiences from other industries show that process quality improvement (PQI) is far more effective than product quality assurance in ensuring quality outputs and cost savings. The PQI approach is becoming more important to the healthcare industry as healthcare professionals struggle to cope with increasing demands for productivity gains, the raising patient acuity and need to curtail the large number of adverse medical events. This paper presents a continuous process quality improvement operational model for healthcare quality improvement and operationalization of the model through the implementation of a computerised clinical pathway management system (CCPMS). It also reports on a small-scale evaluative study conducted to assess the effectiveness of the PQI approach using the CCMPS prototype.

Attitude of Health Personnel↗
PubMed2003

[An economic evaluation on the clinical pathway for gastrectomy].

OBJECTIVE: To analyze the costs of gastrectomy patients treated with the clinical pathway. PATIENTS AND METHODS: Seventy-six patients (path group 44, control 32) had undergone gastrectomy in our hospital in 2001. The clinical pathway included the same care map. Treatment costs were estimated from medical cost receipt data. The economical analysis was performed from the point of the direct cost payer's view. RESULTS: The length of hospital stay in the path group was 27.1 +/- 5.9 days and decreased 8.3 days in comparison with the control(p < 0.001). The cost of the path group was 145.290 +/- 23.773 points and 19.278 points less than the control(p < 0.005). In the path group the operation case per bed was increased 30% and the cost per bed was also increased 15% more than the control. CONCLUSIONS: The implementation of the clinical pathway decreased the length and the cost of hospital stay. The clinical pathway is effective to use the hospital resources, such as bed.

Costs and Cost Analysis↗
PubMedDate not supplied

Postoperative care after esophagectomy: the surgeon's view.

Although in the past esophagectomy was associated with high rates of morbidity and mortality, currently specialized centers have reported reduced hospital death rates of less than 10%. This reduction has been mainly attributed to preoperative patient selection, improvements in anesthesia, surgical techniques, and postoperative care management. In recent years, clinical care pathways, namely physician-directed clinical plans, have been developed to standardize postoperative care after specific surgical procedures: primary goals are improvement in quality of care and reduction in hospital costs. These pathways could be planned after identification of the complications with the highest incidence and the highest hospital costs in order to optimally allocate resources. Aim of this study is to delineate an ideal clinical care pathway after esophagectomy by reporting the most common complications with an overview of advances in perioperative care and providing pointers to what might be achievable.

Critical Pathways↗