Extending the Application of Critical Path Methods

Abstract

Most health care organizations are using critical pathways in an attempt to reduce the variation in patient care, improve quality, enhance communication, and reduce costs. Virtually all of the critical path efforts to date have developed tables of treatments, medications, and so forth by day and have displayed them in a format known as a Gantt chart. This article presents a methodology for identifying the true "time-limiting" critical path, describes three additional methods for presenting the information--the network, precedent, and resource formats--and shows how these can significantly enhance current critical path efforts.

Children and Adolescents With Eating Disorders: The State of the Art

“…39,40 First, professional organizations are supportive of structured approaches, because these treatment regimens help to ensure that patients receive quality care, as well as increase practitioner awareness of accepted approaches to the provision of care for a particular diagnosis. 41,42 A second influence that has contributed to the increased use of treatment protocols is the need to respond to the increased scrutiny of clinical practice by managed care organizations.…”

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“…Previously, the Gantt chart was mostly used as the general format for the clinical pathways and this out- lines a suggested patient care process based on a timetask matrix, listing the components of care in one column and cross-aligning these entries with columns pertaining to time. 1,2,7 Once a pathway is implemented, it should be reviewed as guidelines for coordinated care, which change regularly based on changes in practice, new technologies, and the resources available in different settings. 2 Furthermore, comparing variations in practice, costs, and outcomes, clinicians can reduce future variations.…”

“…1,2,7 Once a pathway is implemented, it should be reviewed as guidelines for coordinated care, which change regularly based on changes in practice, new technologies, and the resources available in different settings. 2 Furthermore, comparing variations in practice, costs, and outcomes, clinicians can reduce future variations. 2 The analysis of pathway variance is vital to achieving expected patient outcomes, the timely discharge of patients, and the appropriate utilization of resources.…”

“…2 A sheet for documenting the clinical pathway was inserted in the patient's chart on admission and patient care was coordinated by surgeons, nurses, anesthesiologists, and pharmacists. Medical staff simply checked off boxes when actions took place in the documented care process.…”

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“…These efforts are an attempt to bridge the gap (Cabana et al, 1999) between updated published guidelines and real-life clinical practice. Nurses were pioneers in developing earlier critical pathways in hospitals for nursing care alone (Ethridge & Lamb, 1989;Miller & Miller, 1997), but multidisciplinary teams soon began developing pathways to encompass all aspects of care for hospitalized patients (Coffey, Othman, & Walters, 1995;Goodman, 1997). As a direct result of this, the implementation of critical pathways and management plans for hospitalized patients is emerging as a useful tool to achieve goals of optimal quality of patient care (Calligaro, Dougherty, Raviola, Musser, & DeLaurentis, 1995;Patterson et al, 1997;Roebuck, 1998).…”