Critical pathways—the pivotal tool

Abstract

Case management is a nursing model that hospital administrators have implemented in an effort to reduce costs and improve quality. The pivotal tool that case management utilizes to standardize treatment plans, trend deviations from the standard, and document care is the critical pathway. Proper development, implementation, and utilization of critical pathways provide health care professionals and administrators with quantitative data on correlations between effective resource utilization and patient outcomes.

Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation

“…25,26 This can be avoided by the use of ICP methodology, which ensures that important areas of treatment are not overlooked and unnecessary delays are prevented by timely intervention. 5,6,9 However, the success of ICP management seen in previous "before and after" studies 13,14,27,28 is not supported by randomized controlled trial data. This may be because stroke rehabilitation units have specialized multidisciplinary input, which reduces the need for additional information, planning, or coordination that an ICP may The duration of therapy represents the time actually spent in treating the patients (face-to-face contact) and has been adjusted for the seniority and number of therapists involved in the treatment session.…”

“…8 The implementation of ICP is often overseen by a healthcare professional designated as the "case manager," who uses the care pathway as the template for provision of appropriate care. 9 This professional is typically an experienced nurse who is empowered to initiate investigations, request referrals, and prescribe medication within the constraints of the pathway without the need for prior medical consultation. 10 ICPs have been piloted successfully in acute and rehabilitation settings and shown to be particularly effective in reducing hospital length of stay and costs in intensive care, management of chronic disorders, and acute stroke care in several nonrandomized studies of differing designs.…”

“…6,7,[11][12][13][14] Some reports suggest that the complex multidisciplinary nature of stroke rehabilitation may be particularly suitable for ICP management. 6,7,9 An ICP provides a time-defined template to organize several related therapeutic activities in parallel at each stage of the rehabilitation process, thus reducing the time needed to undertake these activities. Because the length of hospital stay (rather than investigations, medical care, or therapy input) is the major determinant of costs in stroke rehabilitation, 13,15 a reduction in the duration of inpatient rehabilitation while achieving comparable functional outcome will enhance the efficiency of the rehabilitation process.…”

Care pathways for acute stroke care and stroke rehabilitation: From theory to evidence

“…Care pathways were used as part of case management to promote high-quality patient care that is delivered in a timely and cost-effective manner. 11 Early care pathways were designed for medical conditions or surgical procedures that were regarded as common, 'simple' (that is usually single pathology with little variation in practice), and costly. 12,13 Later, care pathways were applied to manage more complex conditions such as stroke, diabetes, psychotic illness, and palliative care.…”

Integrated Care Pathways and Quality of Life on a Stroke Rehabilitation Unit

“…1,2 This is especially applicable to stroke rehabilitation, which is a paradigm of complex multidisciplinary care and may thus be particularly suited to this approach. It is not surprising that many policy documents, such as the National Services Framework in the United Kingdom 3 and the American Heart Association Stroke Plan, 4 stress the key role of ICP in the development of quality healthcare over the next 5 to 10 years.…”