Designing a Carotid Endarterectomy Critical Pathway for Your Organization

Abstract

The CEA pathway has standardized the care received by this group of patients. By decreasing variation, processes have become routine and more efficient.

Are the outcomes of clinical pathways evidence‐based? A critical appraisal of clinical pathway evaluation research

“…The most often studied category was in the field of cardiovascular surgery and diseases in both the gross sample and study sample (21.5% and 17.4%, respectively). Twenty publications evaluating cardiovascular clinical pathways were included in the study sample [15–34]. The relative number (%) of publications included in the study sample varied between 5% and 16% in the following domains: (1) respiratory diseases, therapy and thoracic surgery [28,35–51]; (2) gastrointestinal surgery, endoscopic surgery and diseases [52–70]; (3) orthopedic surgery and multiple trauma [71–83]; (4) oncological diseases and surgery [84–92]; (5) neurological trauma, disorders, diseases and pain management [93–100]; (6) vascular surgery [15,19,101–105]; and (7) gynaecological diseases, surgery and maternity care [106–111].…”

“…However, decreases in LOS, costs, readmission rates and number of complications were not statistically tested in 12.3%, 28.8%, 20.8% and 27.1% of the studies, respectively [16–19, 22,23,25–28,32,33,36–38,42,44–47,49,53,61,75,85,88,91,92,99–103,105,110,113,120]. There were studies that used a statistical test to decide whether a difference between a clinical pathway group and a control group was due to sample fluctuation, but they also reported other differences without this test.…”

“…In relation to the internal and external validity of the studies in the sample, our analysis revealed several factors that influenced the quality of clinical pathway evaluation. Most studies in our sample concerned non-randomly selected small patient populations without a power analysis [19,23,25,36,52,54,56,58,59,61,76,81,[86][87][88]91,99,107,111,118,122,123,126,128].…”

“…The most often studied category was in the field of cardiovascular surgery and diseases in both the gross sample and study sample (21.5% and 17.4%, respectively). Twenty publications evaluating cardiovascular clinical pathways were included in the study sample [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The relative number (%) of publications included in the study sample varied between 5% and 16% in the following domains: (1) respiratory diseases, therapy and thoracic surgery [28,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]; (2) gastrointestinal surgery, endoscopic Table 1 The evaluation items used to assess the methodological quality of the studies investigated Was a power analysis performed?…”

Evidence‐based re‐engineering: re‐engineering the evidence

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