Critical pathways intervention to reduce length of hospital stay

Initiation of a Critical Pathway for Pancreaticoduodenectomy at an Academic Institution—the First Step in Multidisciplinary Team Building

“…A number of studies have been published that question the value of critical pathways (11)(12)(13)(14). These critiques revolve around three main points.…”

“…Critics note that lengths of stay were declining prior to pathway implementation and that rates of decline were not increased by most pathways (13). Secondly, the selective application of pathways in some reports (4) is used by critics as evidence that the performance improvements attributed to critical pathways are simply the result of patient selection bias (12). Critics claim, accurately, that if healthier patients are placed on critical pathways, while patients with greater co-morbidities are placed in non-pathway control groups, then outcomes will invariably improve, independent of the efficacy of the pathway itself.…”

“…Recently, several reviews have been published that question the true value of critical pathways (11)(12)(13)(14)(15). The criticisms contained in these articles include (1) the possibility that performance improvements are the result of patient selection bias, with only healthy patients "cherry picked" for inclusion in pathway treatment giving unfair advantage over unfiltered pre-pathway controls or, (2) that only pathway implementation with substantial improvements get reported (12).…”

“…The criticisms contained in these articles include (1) the possibility that performance improvements are the result of patient selection bias, with only healthy patients "cherry picked" for inclusion in pathway treatment giving unfair advantage over unfiltered pre-pathway controls or, (2) that only pathway implementation with substantial improvements get reported (12). Additionally, the articles collectively cite a universal decrease in length of hospital stay as a secular trend across all of medicine, for which pathways are being given unfair credit (14).…”

Implementation of a Critical Pathway for Patients with Acute Cholecystitis

“…7 Critical pathway implementation has several advantages. First, quality of medical care can be improved.…”