Taking the right pathway. Critical pathways are a road map to care.
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Cost Control↗
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Opportunities for pharmaceutical care with critical pathways.
Critical pathways are multidisciplinary tools designed to improve patient care and efficiency. Almost every path requires some type of pharmacotherapeutic intervention, from selection of surgical prophylaxis to management of anticoagulation. Pharmacists should become involved with the critical pathway process because it offers an excellent opportunity to incorporate pharmaceutical care and to meet Joint Commission on Accreditation of Healthcare Organization compliance criteria.
Clinical Protocols↗
Expanding the use of critical pathways in critical care.
Critical pathways are known to decrease the patient's length of stay while simultaneously using resources effectively and efficiently. Several additional functions of critical pathways exist: pathways are used as tools for teaching; to predict and prevent complications; streamline charting; and anticipate staffing needs. These and other functions of critical pathways are described as they apply to critical care patients.
Clinical Protocols↗
Critical pathway experience at Cedar-Sinai Medical Center.
Critical pathways provide an excellent tool for promoting multidisciplinary efforts to develop optimal, cost-competitive plans for managing patient care. The pharmacy department can play a variety of roles in developing and implementing critical pathways. In advocating optimal drug selection and monitoring, pharmacists can help their institutions reduce costs while maintaining or improving quality of care.
California↗
Marketing critical pathways in critical care.
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Critical Care↗
Critical pathways.
A critical Pathway (CP) is a clinical management tool that helps medical care providers coordinate the delivery of patient care for a particular case type or condition. As a guide to usual treatment patterns, a CP gives a view of the "big picture." The CP usually recommends a total treatment regimen. Treatment regimens are formulated through the consensus of a multi-disciplinary collaboration of all those involved in a patient's care. If developed and implemented properly, critical paths can lead to desirable outcomes for the patient and improved operating effectiveness/efficiency for the healthcare facility. Components of CPs often include protocols, algorithms, and clinical practice guidelines. Metrics, bench-marks, compliance, and variances become common terms among members of the healthcare team. Although CPs have gained wide acceptance as inpatient management tools, they are rapidly being sought for outpatient settings as well. This article details the CP process and cites examples of two hospitals that have used CPs to reduce length of stay and cut costs.
Anesthesiology↗
Being led down the critical pathway: a perspective on the importance of care managers vs critical pathways for patients requiring prolonged mechanical ventilation.
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Case Management↗
Critical pathway management of unstable angina.
The critical pathway for UA is a multidisciplinary management tool designed to assist in expediting the treatment and evaluation of this frequent clinical syndrome. No critical pathway or practice guideline will meet the needs of all patients, and flexibility for patient variations and physician judgment is mandatory. Prediction tools and other facilitators cannot replace and must not impede the thoughtful assessment of complex clinical situations. Numerous factors, occasionally social or political in nature, impact on patient treatment strategies and the application of interventions. It is our hope that the Unstable Angina Critical Pathway will form a foundation for further innovation and cooperative effort toward optimizing the management of patients with acute ischemic syndromes.
Acute Disease↗
Critical pathways: an aid to practice.
The introduction of critical pathways in a invasive cardiology unit has resulted in a reduction in time spent on documentation by nursing staff, in patient complaints and an improvement in the quality of information collected, as measured by clinical audit. This paper describes the transition from the use of nursing care plans to multidisciplinary critical pathways. The positive and negative aspects of critical pathways and their implementation are explored.
Critical Pathways↗
The role of the nurse educator in the development of critical pathways.
This article focuses on the role of the nurse educator in developing critical pathways. It serves as a guide for the nurse educator by defining how critical pathways support managed care, identifying the goals of critical pathway education, and reviewing the importance of organizational commitment to the critical pathways before their use. The nurse educator serves as instructor, facilitator, and consultant in critical pathway development.
Education, Nursing, Continuing↗
Process-oriented critical pathways in inpatient psychiatry: our first year.
The critical pathway methodology of assigning and timing staff interventions and expected patient outcomes has developed worldwide recognition, but is less likely to be used in psychiatry than in other medical fields. At St. Mary's in Rochester, New York, an interdisciplinary team adapted the critical pathway concept to meet the needs of an acute inpatient population with relative success. Although staff education needs continue and plans to modify the pathway are in progress, all staff feel that the critical pathway is a viable tool for enhancing patient care and optimizing resources use. Benefits, obstacles, and suggestions are discussed.
Critical Pathways↗
Critical pathway methodology: effectiveness in congenital heart surgery.
Critical pathway methodology has been demonstrated to provide producible reduction in average length of stay (ALOS) in adults in certain diagnostic-related groups and operations such as coronary artery bypass grafting. The efficacy of this approach in congenital heart surgery was explored. Two hundred eighty-six consecutive patients from a health maintenance organization treated by a single surgeon since the institution of diagnostic-related group coding at that health maintenance organization constituted the study group. One hundred fourteen patients were treated at a university hospital without critical pathway methodology (group 1) and 172, subsequently at the health maintenance organization institution using the methodology (group 2). Operation/lesion, age, and diagnostic-related group matching was possible in 61 pairs. Examination of the ALOS Hospital (operative and postoperative days) for the entire cohort revealed a 43.8% reduction in ALOS Hospital (p < 0.0001) and a 39.0% reduction in ALOS Intensive Care Unit (p < 0.0001). There was also significant reduction in ALOS Hospital and ALOS Intensive Care Unit in the operation/lesion-matched subsets. Outcome measures including operative and late mortality, readmission, unscheduled emergency room and clinic visits, and health maintenance organization family assessment survey demonstrated no improvement in outcome with increased hospital stay. Thus, critical pathway methodology when used in patients undergoing a congenital heart operation produces a significant reduction in hospital stay and intensive care unit stay as well as quality patient care with uniformity of outcome.
Adolescent↗
Use of critical pathways and indicators in pharmacy practice.
The development of critical pathways along with continuous quality improvement and patient-focused care represents one of the key initiatives in health care in the 1990s. The critical pathway defines the components of care, including treatments, diagnostic measures, and activities to be performed each day, to achieve the desired outcome for a patient with a given diagnosis. Indicators can then be used to define opportunities for improving the pathway. Participation in the critical pathway development process provides pharmacists with an opportunity to utilize their expertise in the medication use process to ensure optimal medication management.
Clinical Protocols↗
Critical pathways as a strategy for improving care: problems and potential.
In an era of increasing competition in medical care, critical pathway guidelines have emerged as one of the most popular new initiatives intended to reduce costs while maintaining or even improving the quality of care. Developed primarily for high-volume hospital diagnoses, critical pathways display goals for patients and provide the corresponding ideal sequence and timing of staff actions for achieving those goals with optimal efficiency. Despite the rapid dissemination of critical pathway programs in hospitals throughout the United States, many uncertainties remain about their development, implementation, and evaluation. In addition, serious concerns have been raised about their effect on patient outcomes and satisfaction with care, physician autonomy, malpractice risks, and the teaching and research missions of many hospitals. Underlying these concerns is the absence of data from controlled trials to evaluate the effects of critical pathways. Physicians should understand the potential benefits and problems associated with critical pathways because physicians are increasingly being asked to provide leadership for pathway programs. Physicians and other health service investigators should also develop methods to study pathways in evolving health care settings. Although the promise of reduced costs and improved quality is enticing, the gaps in our knowledge about critical pathways are extensive; therefore, like any new health care technology, pathway programs should be fully evaluated in order to understand the conditions under which that promise may be fulfilled.
Analysis of Variance↗
Role of the clinical nurse coordinator in successful implementation of critical pathways in pediatric cardiovascular surgery patients.
Critical pathways reduce variations in clinical management and achieve quality patient outcomes within a defined time while reducing the average length of stay (ALOS). The critical path is a day-by-day plan that specifies the use and timing of procedures in relation to the stage in the patient's recovery. Variations from that plan are identified and aggressively approached. This article outlines the clinical nurse coordinator's role in utilizing critical pathways for the congenital heart surgery patients. Successful implementation of the pathways using the clinical nurse coordinator's role is supported by analysis of ALOS in 286 patients.
Cardiovascular Diseases↗
Critical pathways as an effective tool to reduce cardiac transplantation hospitalization and charges.
A critical pathway is a component of managed care focusing on outcome-oriented, cost-effective care. This retrospective review of 74 cardiac transplants in 72 patients evaluated the influence of critical pathways on clinical management, length of hospitalization, and hospital charges. Transplant patients were divided into group 1 (n = 51), which received standard primary nursing care, and group 2 (n = 23), which received nursing case management using a critical pathway. The number of intensive care unit days for group 2 was significantly smaller than for group 1, as were duration of hospitalization and hospital charges. The critical pathway provided for systematic delivery of care and decreased length of hospitalization and charges without compromising safety or quality.
Case Management↗
Nursing case management in the neonatal intensive care unit, Part 2: Developing critical pathways.
Nursing case management is a model of care delivery that focuses on achieving optimal patient outcomes in expected time frames while containing costs. The critical pathway is a tool used to help the team achieve the goals of nursing care management. The critical pathway serves as a multidisciplinary plan of care, based on time. Few neonatal critical pathways are available in the literature. They can be easily developed through a collaborative process. This article presents the author's recommendations on how to develop critical pathways. Once developed, they can serve as an important source of communication among disciplines and as a source of information regarding patient outcomes. Critical pathways can also be used as a teaching tool. Two critical pathways are included in this article.
Humans↗
Coordinating initiatives in critical pathways and information systems.
Health care providers have begun to use critical pathways and order sets to standardize clinical care in order to improve clinical resource management. This article describes ways that critical pathways and order sets can be developed and implemented in a coordinated manner. This approach allows for a process that facilitates automation of critical pathways variance analysis and continuous feedback to clinicians.
Cost Control↗