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Results for “Critical Pathways”

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At least 19 recordsLinked to original sources
PubMedDate not supplied

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↗
PubMed1995

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗
PubMed1994

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↗
PubMed1995

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↗
PubMed1995

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↗
PubMed1995

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↗
PubMed1995

Enhancing patient care: case management and critical pathways.

This paper describes the processes involved in case management and in developing critical pathways as a mechanism to improve customer focused care. Critical pathways can be used to manage the care of patients in settings as varied as acute care hospitals, tertiary care facilities and primary health care areas. Advantages and disadvantages of case management and the critical pathways method of management are outlined from a nursing perspective.

Case Management↗
PubMedDate not supplied

Thoracotomy, critical pathway, and clinical outcomes.

Using a multidisciplinary critical pathway for chest surgery, the staff of Saint Joseph Medical Center (Burbank, California) and its physicians developed a strategy leading to improved patient outcomes with reduced overall costs. On referral from the surgeon's office, the multidisciplinary team, consisting of a clinical nurse specialist, physical therapist, and respiratory therapist, meet with the patient. The education that follows includes discussion of the surgical procedure, intubation, incentive spirometry, coughing, deep breathing, early ambulation, use of patient-controlled analgesia, chest physiotherapy, transfusion options, and evaluation of health status. A few days later, the patient undergoes the thoracoscopy-assisted thoracotomy. The success of the outcome-driven critical pathway can be related to several factors: (1) close coordination between the surgeon's office and hospital; (2) intensive preoperative education that decreases patient's anxiety and increases his or her ability to participate in recovery; (3) patient-controlled analgesia, nerve blocks, non-narcotic analgesia, and preemptive rehabilitation, which limit the risk for complication; and (4) thoracoscopy, which limits the surgical morbidity commonly affiliated with thoracotomy. The pathway, used for 160 patients during the past 2 years, has shown dramatic results related to reducing morbidity, practice variation, delay, and total overall cost.

Adult↗
PubMed1996

A critical pathway to treat proximal lower-extremity deep vein thrombosis.

To address variation in treatment of deep vein thrombosis (DVT) while maximizing the efficiency and quality of care, our institution developed a critical pathway guideline. This paper presents this critical pathway and the clinical rationale underlying its recommendations. The DVT pathway synthesizes recommendations for all aspects of patient care, including laboratory evaluation at admission, dosing and management of heparin therapy, timing of warfarin initiation, elements of patient education, discharge planning, and anticipated duration of heparinization and hospitalization. Differences among interpretations of the medical literature, patient populations, physician skills, test availability, and other variables make it unlikely that all elements of this pathway would best meet the needs of another institution. Nevertheless, the critical pathway format and the specific contents of this pathway may serve as a useful benchmark for others involved in creating clinical guidelines for this patient population.

Activities of Daily Living↗
PubMed1996

Critical pathways: a road to institutionalizing pain management.

Effective strategies to increase the visibility of pain and the accountability of health-care professionals for the treatment of pain are needed to improve the quality of pain management. Critical pathways are tools used to plan and document care for patients within a system of case management. Case management models of care focus on decreased cost, better coordination of services, and improved patient outcomes. This article describes how critical pathways are being used in one setting within a system of case management to help increase awareness of pain as a problem and to institutionalize pain management. As institutions seek to implement outcome-based practice systems, many are turning to the critical pathway to influence practice patterns. Critical pathways provide the vehicle to articulate and implement a standard for quality pain management and a mechanism to analyze persistent failures in achieving desired outcomes of care. Using pathways to track and monitor care promises to uncover clinical barriers to pain management and provide an impetus to increase clinician accountability for pain relief.

Critical Pathways↗
PubMed1994

Developing a critical pathway for orientation.

A direct correlation exists between job satisfaction and employee retention with an organized and compassionate orientation process for new employees on a nursing unit. It is generally recognized that preceptorship/mentoring is the most desirable orientation modality; however, situations occasionally require orientees to work with several preceptors with varying levels of proficiency. A program based upon a framework designated "critical pathway" was established in a coronary care unit and a cardiac progressive care unit to organize orientation information into weekly segments, with each week's content building upon the previous week's information. Because the critical pathway clearly delineates the orientation content, all necessary information is imparted to the orientee in an organized fashion without omitting pertinent details. Problems with orientation are documented as variances on the critical pathway, and are discussed between the preceptor and orientee during weekly evaluation sessions. This article reports the procedure for developing a critical pathway for orientation using the critical pathway concept, which is adapted from the nursing case management practice model.

Coronary Care Units↗
PubMed1995

A critical pathway to evaluate suspected deep vein thrombosis.

Uncertainty regarding the optimal evaluation of suspected deep vein thrombosis (DVT) results in wide variations in practice, even within the same institution. To address variation in practice while maximizing the efficiency and quality of care, our institution developed a critical pathway guideline for the emergency department evaluation of patients suspected of having DVT. We present the critical pathway and the clinical rationale underlying its recommendations. The critical pathway was developed by a multidisciplinary team using chart review of practice at our institution, benchmarking at other institutions, and review and discussion of the medical literature. Consensus was achieved for the selection of ultrasound as the primary imaging test for all patients and for recommending initial doses of heparin sodium that are higher than the current norm at our institution to reduce the length of time required to achieve therapeutic anticoagulation. A total time for patient evaluation of 5 hours or less was established as the target. Controversy arose in two key areas: (1) the treatment of patients with normal ultrasound scans when high clinical suspicion for DVT exists and (2) the evaluation and treatment of suspected isolated calf-vein DVT. In its final form, the critical pathway recommendations seek to balance the benefits of standardization with the prerogatives of physicians to make decisions tailored to individual patients.

Decision Making↗
PubMedDate not supplied

Critical pathways: the time is here for pharmacist involvement. American College of Clinical Pharmacy.

Successful development, implementation, and assessment of the effectiveness of critical pathways involves many processes and tools. Numerous pathways have been developed and the value of this tool in improving patient care has been demonstrated in some patient groups.27,29 Pharmacists are becoming more involved, but the window of opportunity is small. Critical pathways are routinely being utilized to optimally sequence time-appropriate interventions of the interdisciplinary plan of care set forth to achieve patient satisfaction and desired outcomes. Pharmacists must seize the chance to provide pharmaceutical care and assure their participation in the development and implementation of critical pathways.

Critical Pathways↗
PubMed1995

Critical pathway for administering high-dose chemotherapy followed by peripheral blood stem cell rescue in the outpatient setting.

PURPOSE/OBJECTIVES: To explain the rationale and process of outpatient critical pathway development for sequential high-dose chemotherapy followed by peripheral blood stem cell transplantation. DATA SOURCES: Published books and journal articles. DATA SYNTHESIS: Complex treatment for patients with metastatic breast cancer is shifting to the outpatient area. To make this therapy safe and cost effective, a process for monitoring this type of outpatient care needs to be developed. CONCLUSIONS: Collaboration with a multidisciplinary team is important in ensuring quality of care for complex outpatient treatment protocols. Critical pathway development can serve as a road map for delivering this care. IMPLICATIONS FOR NURSING PRACTICE: As team leaders, nurses should oversee the critical pathway development and implementation. Nurses also should maintain their role of patient advocacy through monitoring pathway compliance.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

The effect of developing patient compendiums for critical pathways on patient satisfaction.

We examined the impact of developing a patient compendium to a critical pathway on patient satisfaction scores. It was our hypothesis that by sharing the contents of a critical pathway, by using a patient compendium, we would improve patient satisfaction by establishing realistic patient expectations for patients undergoing cardiac bypass graft surgery. A satisfaction survey was sent to patients before the hospital began to use the patient compendium to the pathway and to another group of patients after initiation of a compendium. Although there were some trends suggesting an improvement in patient satisfaction scores, there was no statistical difference in satisfaction before or after the compendium was in use.

Coronary Artery Bypass↗