Powerpoint presentation on CRITICAL PATHWAYS.pptx

Powerpoint presentation on CRITICAL PATHWAYS

1. CRITICAL PATHWAYS

2. Introduction These are the multidisciplinary plans of best clinical practice. Critical Pathways were introduced in the early 1990s in the UK and the USA, and are being increasingly used throughout the developed world.

3. Contd… “The survival of health care institutions depends upon a delivery system focusing on appropriate use of resources & controlling length-of-stay while monitoring clinical progress towards identified outcomes. Using a clinical path as a tool for managing resources, research activities, continuous quality improvement, & increased collaborative practice can enhance the professional practice environment & benefit patient care” (Clark & Anderson, 1994).

4. Contd… They provide detailed guidance for each stage in the management of a patient (treatments, interventions etc.) with a specific condition over a given time period, and include progress and outcomes details.

5. Other Synonyms Clinical Pathways Integrated Care Pathways Multidisciplinary pathways of care Pathways of Care Care Maps Collaborative Care Pathways

6. Definition Critical pathways are one method of planning, assessing, implementing and evaluating the cost-effectiveness of patient care. or Critical pathways are predetermined courses of progress that patients should be making after admission for a specific diagnosis or after a specific surgery.

7. Contd… A visualization of the patient care process (Coffey et al; 1992) A timeline that identifies expected patient outcomes & associated interventions for a specific diagnosis or class of cases, often defined by a diagnosis-related group (DRG) ( Grifen & Griffen , 1994)

8. Care MAP An abbreviation for a care Multidisciplinary Action Plan , which combines a nursing care plan with a critical path. The care plan component is similar to the care plans typically used, except a time is indicated for each intervention of the nursing diagnosis.

9. For e.g. A critical pathway for a specific diagnosis might suggest an average length of stay (ALOS) of 4days and that the patient should have certain interventions completed by certain points on the pathway (much like PERT diagram). Any patient’s progress found to be not in compliance with the critical pathways prompts a variance analysis regarding why the critical pathways has been violated.

10. Contd… Although critical pathways are used as tool for monitoring quality of care, they can also be used as a fiscal planning tool. Once the cost of a pathway is known, analyzing the cost-effectiveness of the pathway is possible (Gardner, et al., 1997) With this clinical and cost variance data, decisions on changing the pathways can be made with both clinical and financial outcome projections.

11. Goals of critical pathways

12. Characteristics of Critical Pathways

13. Provide guidelines for practice. Define outcomes. Focus on timelines. Use resources efficiently. Emphasize the need for coordination, communication & collaboration. Include the patient & family. Provide interdisciplinary effort.

14. Components of critical pathways Critical Pathways have four main components (Hill, 1994, Hill 1998):

15. Critical Pathway Development

16. Importance of critical pathways Critical Path Analysis is an effective and powerful method of assessing:

17. What tasks must be carried out

18. The shortest time in which you can complete a project

19. Resources needed to execute a project

20. The sequence of activities, scheduling and timings involved

21. Task priorities

22. The most efficient way of shortening time on urgent projects

23. Critical path method (CPM) The critical path method (CPM) was invented by project managers in the early 1950's.

24. contd… It is a procedure for using network analysis to identify those tasks which are on the critical path i.e. where any delay in the completion of these tasks will lengthen the project timescale, unless action is taken. For all tasks off the critical path, a degree of tolerance is possible (e.g. late start, late completion, early start, etc.).

25. Contd… Network charts and CPM analysis used to be carried out by hand. Software is now available which requires the user only to enter the tasks, duration of each task and dependencies upon other tasks; a network chart and CPM is then automatically created.

26. Variance In Critical Pathway

27. Contd… If the progress deviates from the normal path, a variance is indicated. A variance is anything that occurs to alter the patient’s progress through the normal critical path . Analysis of variance is essential for effective utilization of a path.

28. Causes of Variance Circumstances that can cause a variance include operational, provider, patient, or clinical elements. Operational causes include broken equipment or interdepartmental delays. Changes in the practice pattern of the healthcare provider can affect the pathway & cause a variance.

29. Types of variance Variances can be positive or negative. A negative variance is an undesired outcome, whereas A positive is an outcome that is achieved before it is expected.

30. Contd… Complications in the patient’s condition, such as a hemorrhage into the joint after TKR, may increase total hospital days. A complication can inhibit the ability of the patient to meet the clinical indicator as described in the path. A patient or family’s refusal of a specific component of care can create a variance.

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