Development Of Critical Pathways Research Articles

Development of critical pathway for ABO incompatible kidney transplant patients

Development of critical pathway for ABO incompatible kidney transplant patients

Chapter 23 - Organ donation protocols

Organ transplantation improves survival and quality of life in patients with end-organ failure. Waiting lists continue to grow across the world despite remarkable advances in the transplantation process, from the creation of public engagement campaigns to the development of critical pathways for the timely identification, referral, approach, and treatment of the potential organ donor. The pathophysiology of dying triggers systemic changes that are intimately related to organ viability. The intensive care management of the potential organ donor optimizes organ function and improves the donation yield, representing a significant step in reducing the mismatch between organ supply and demand. Different beliefs and cultures reflect diverse legislations and donation practices amongst different countries, creating a challenge to standardized practices. Maintaining public trust is necessary for continued progress in organ donation and transplantation, hence the urge for a joint effort in creating uniform protocols that ensure transparent practices within the medical community.

Proposal of Laboratory Test Panel Based on Patients’ Chief Complaints in Emergency Department

A test panel is a group of tests that are simultaneously performed for diagnosis and follow-up of patients. Organ-specific or disease-specific test panels are currently available. Since the patient's chief complaint plays a key role in obtaining the personal and medical history and performing physical examinations, we proposed a test panel based on the chief complaints of the patients. We collected data from 3,127 adults with apparent symptoms who visited the emergency department from April 2009 to May 2009. Subsequently, we classified the patients' chief complaints, ordered the laboratory tests on the basis of these complaints, considered the patients' disease entities, and reviewed the relevant literature. The patients were categorized into 14 groups on the basis of the most common chief complaints presented in the emergency department. We first selected the basic test panels and then organized the test panel for each chief complaint to enable differential diagnosis. We proposed test panels based on the chief complaints of the patients; these test panels could allow rapid diagnosis and be more useful than the organ-specific or disease-specific tests in critical pathway development. The next step will be evaluating the efficiency and cost effectiveness of the test panel that we suggested.

がん診療連携拠点病院の地域連携クリティカルパス準備段階における連携施設の受け入れ態勢調査

がん診療連携拠点病院の地域連携クリティカルパス準備段階における連携施設の受け入れ態勢調査

Development of Critical Pathway for Laparoscopic Assisted Vaginal Hysterectomy by CPA program

Objective: The aim of this study was to develop critical pathway for post operation care of laparoscopic assisted vaginal hysterectomy with time and cost effectiveness using a clinical pathway assistant program (MDCPATM, MDware Co.) Methods: Procedure was done with the following steps; establishment of conceptual framework, development of preliminary critical pathway using CPA program, expert validity test, and confirmation of final critical pathway. Results: Preliminary critical pathway was extracted by CPA program, and this result was verified by expert validity test. The process of data collection and analysis to develop the preliminary critical pathway was accomplished automatically by CPA program. The patients' hospitalization period in the aspect of time and cost effectiveness was confirmed as 6 days, and each item of assessment, test, medication, treatment, diet, activity, and teaching were finalized. Conclusion: The CPA program can automate the complicated process, which contains collecting and cleaning the large size EMR data, classifying and confirming the items in critical pathway, so that the time and cost to develop a critical pathway can be reduced. This program is expected to be used for development of critical pathway in a variety of clinical settings in the aspect of time and cost effectiveness. (Journal of Korean Society of Medical Informatics 14-1, 25-35, 2008)

Critical Pathways for the Management of Stroke and Intracerebral Hemorrhage

Thirty-day mortality rates in patients with spontaneous intracerebral hemorrhage (ICH) range from 35% to 50%, with only 10-20% of the survivors regaining functional independence. This high mortality and morbidity argues for the optimization of emergency medical services (EMS), emergency department (ED), and in-patient treatment paradigms. With the development of interventional strategies for ICH, both pharmacologic and surgical, time to treatment will be critical to improving outcomes. Similar to acute ischemic stroke care, proper preparation and role definition will be critical for efficient evaluation and treatment. We studied the existence and structure of ICH management protocols in US hospitals. A national survey of Emergency Medicine physicians was conducted to gather information regarding the existence of stroke and ICH treatment protocols at their institutions. A clearly established pathway for the management of ischemic stroke exists in most hospitals (78%). By contrast, only 30% of hospitals have a clearly defined pathway for ICH. Thus, while most hospitals are able to perform rapid computed tomography (CT) scans to diagnose ICH, the management of these patients post-CT is more fragmented and variable. Few hospitals have comprehensive protocols that include treatment policies for raised intracranial pressure or formal policies for the transfer of patients to centers with neurocritical care/neurosurgical resources. Integration of ICH critical pathways into stroke protocols could potentially improve the high mortality and disability associated with this condition and might facilitate ongoing studies of ICH-specific interventions. With stroke neurologists and neurocritical care specialists showing an increasing interest in ICH management, development of critical pathways may allow for a standardized approach to best treatment practices within institutions and networks as evidence grows for new treatments and management strategies. This may also allow a redefinition of the roles of team members, including ED and critical care physicians, neurologists, and neurosurgeons.

ASHP Guidelines on the Pharmacist's Role in the Development, Implementation, and Assessment of Critical Pathways.

Because pharmacotherapy is a central component of many critical pathways, pharmacists should take leadership roles in their development, implementation, and assessment. Pharmacists can improve the development of critical pathways by ensuring the evidence-based selection of medications, establishing measures for monitoring patients for drug efficacy and adverse effects, and evaluating the proposed critical pathway for patient safety. Pharmacists can improve the implementation of critical pathways by documenting processes and outcomes, ensuring proper patient selection and medication use, monitoring patients for drug efficacy and adverse effects, and providing for continuity of care. Pharmacists can improve the assessment of critical pathways by measuring and analyzing processes and outcomes, disseminating the results of those analyses, and reviewing the critical pathways' pharmacotherapy to keep pace with changes in best practices.

Chapter Seven: Responses, Relief, and Recovery

AbstractAll damage requires some response. Responses are directed towards the mitigation of further damage once the impact of an event has begun and/or correcting the functional deficits created by the primary and secondary events, and restoring the functionality of the damaged elements to their respective pre-event state. Disaster responses are directed towards search and rescue, relief, recovery, and/or rehabilitation. Responses must be directed at satisfying all or part of defined needs. Implementation of responses must be coordinated through a Coordination and Control Center. Thus, all responses must be driven by clearly stated goals and objectives directed towards specific needs. The Disaster Critical Control Point (DCCP) is the time at which the available supplies balance all of the needs. Selection of appropriate indicators that reflect the severity of the damage and the effectiveness of the response in meeting its goals and objectives and the benefit to society that results is crucial. Use of appropriate indicators eventually will result in the evolution of minimum and optimum standards, and definition of functional and critical thresholds. Evolution of such standards and thresholds will lead to the development of critical pathways (process evaluation) and guidelines to be used in optimizing future responses. All of the steps from preparedness to recovery that are undertaken to minimize the damage and restore the pre-event status are the tasks of disaster management.

Study on the Development of Critical Pathway for the Cesarean Section using Data Mining Technique

Study on the Development of Critical Pathway for the Cesarean Section using Data Mining Technique

Merit and demerit in development of critical pathways

Merit and demerit in development of critical pathways

Critical Pathway Development for the Hysterectomy Patients and its applied Effect

Critical Pathway Development for the Hysterectomy Patients and its applied Effect

Critical pathway development: an integrative literature review.

The purpose of this integrative literature review was to summarize and analyze the methods used to develop critical pathways. Relevant articles published in occupational therapy, physical therapy, nursing, and medical journals between 1992 and 1997 were reviewed to extract various methods and the steps or criteria used for each method. Nine approaches to critical pathway development and the steps or criteria involved in each method are presented in tabular format. The most detailed approach was used as a gold standard, and the other approaches were compared to it. This review should assist occupational therapy practitioners working with various diagnostic populations to understand the methods used, and steps involved, in the development of critical pathways. It should also serve as a resource for practitioners who have the opportunity to participate in critical pathway development.

Critical pathways : a review. Committee on Acute Cardiac Care, Council on Clinical Cardiology, American Heart Association.

Critical pathways, also known as critical paths, clinical pathways, or care paths, are management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency.1 As competition in the healthcare industry has increased, managers have embraced critical pathways as a method to reduce variation in care, decrease resource utilization, and potentially improve healthcare quality. Cardiovascular medicine in particular is an area in which critical pathways have been embraced. This is due in part to the high volume and high cost associated with cardiovascular diseases and procedures. In addition, the relatively mature guideline process has also contributed to the growth in use of critical pathways in cardiology. Although anchored in clinical guidelines, the critical pathway is a distinct tool that details processes of care and highlights inefficiencies regardless of whether there is evidence to warrant changes in those processes. Clinical guidelines, on the other hand, are consensus statements that are systematically developed to assist practitioners in making patient management decisions related to specific clinical circumstances.2 Although clinical guidelines can and should be used in pathway development, the majority of processes included in a pathway have not been rigorously tested and are generally not addressed in guidelines. Another term that should also be distinguished from critical pathways is clinical protocols. Protocols are treatment recommendations that are often based on guidelines. Like the critical pathway, the goal of the clinical protocol may be to decrease treatment variation. However, protocols are most often focused on guideline compliance rather than the identification of rate-limiting steps in the patient care process. In further contrast to critical pathways, protocols may or may not include a continuous monitoring and data-evaluation component. Critical pathway techniques were first developed for use in industry as a tool to …

Introduction and development of critical pathway

Introduction and development of critical pathway

Managed Care and Critical Pathway Development

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.

Issues related to caring for infants to adults on an integrated epilepsy unit.

We integrated the care of patients of all ages (ranging thus far from 4 weeks to 73 years) in our dedicated 8-bed Epilepsy Unit. Administrative issues pertaining to admission and discharge criteria, unit policies and procedures and an interdisciplinary quality assurance plan were examined in relation to the impact of combining both pediatric and adult patients. Clinical considerations included the diversified abilities needed to care for pediatric and adult patients both in relation to the technical skills as well as psychosocial skills required. The advantages of integrating patients of all ages on one unit include having a staff highly trained in assessment and intervention skills for a particular disorder. The psychosocial issues that arise in these patients, regardless of age, tend to encompass the entire family; therefore a holistic approach is appropriate for both children and adults. An autonomous nursing practice was established with the development of critical pathways and patient care protocols. Our experience suggests that integrated specialized units can enhance the care of patients with intractable seizures.

Impact of a Critical Care Pathway for Unstable Mechanically Ventilated Patients

This article describes outcomes-oriented care through the development and implementation of a multidisciplinary critical pathway for the patient with hemodynamic or respiratory instability. The pathway outlines high quality care based on practice guidelines designed to maintain or improve outcomes while minimizing the financial burden to the institution. This article focuses on critical pathway development and implementation, includes specific goals and interventions for each phase of illness, and describes the multidisciplinary process used in conjunction with pathway implementation. Evidence-based practice changes were based on the literature and resulted in streamlined nursing documentation, demonstration of quality outcomes, highlighting the value of the pathway as a cost efficient tool.

Critical Pathways: Occupational Therapists' Role in Development and Utilization

Managed care is mandating that healthcare facilities implement cost containment measures. Critical pathways are one popular tool used to meet this demand. The purpose of this study was to explore current involvement of occupational therapists (OTRs) in the use and creation of critical pathways.Results of a national survey showed 70.5% of the respondents reported they are not currently using critical pathways. A majority of OTRs are not and have not taken an active role in critical pathway development. Furthermore, the majority indicated having no knowledge of future critical pathway implementation in their facilities.Information gathered from those OTRs reporting critical path use included most common diagnoses using the paths and percentages of OTRs utilizing critical paths in specific occupational therapy areas.The conclusions drawn by the researchers indicated the need for OTRs to become more involved in the development and utilization of this multi-disciplinary approach to treatment. For OTRs to maintain and enhance their positions within the allied health profession, proactive involvement with these managed care driven quality assurance methods is essential.

The Development of Critical Pathways in Home Infusion

Critical paths have been used successfully in the acute care facility to manage resources with satisfactory patient outcomes since 1985. Clinical pathways exhibiting significant impact in length of stay and cost savings have included home care. Organizations are also beginning to implement clinical pathways in home health agencies. Many include pathways for home infusion. This article reviews the evolution of clinical pathways in the acute care facility, home care, and home infusion. The benefits and barriers in each environment are included. Recommendations on the developing critical pathways are, detailed.

The Role of the Pharmacist in Developing Critical Pathways with Warfarin Therapy

The pharmacist can play a key role in the development of critical pathways for disease states with warfarin as a component of therapy. The pharmacist must be familiar with the complex therapeutic considerations involved with warfarin therapy. This paper will briefly review warfarin therapeutics and will discuss strategies for pharmacist involvement in development of critical pathways including warfarin therapy. Participation in the multidisciplinary planning of critical pathways provides an excellent opportunity to contribute to the efficient, safe, and cost-effective use of warfarin.