CLINICAL PATHWAY FOR CONGESTIVE HEART FAILURE

Clinical Pathway for Congestive Heart Failure

Clinical Pathway for Congestive Heart Failure

As we move towards end of this century, health care is undergoing huge change at rapid pace. Especially in political agenda of many countries is debate about quality of care and cost containment. (Grudich 1991)

There is also increasing demand for more appropriate uses of technology, more coordinated care and improve caregiver-patient communication. Recent trends show an increasing trend for public to practice and competition. There is also worrying trend towards an increase in malpractice suits for medical malpractice. (Weaver 1995)

The community hospital risk management has become increasingly important to many health organizations. Given all these pressures, health organizations have developed strategies to reduce resource utilization while maintaining quality of care. Some of underlying causes of above problems can be traced back to process of actual care delivery.

The absence of system of formal planning care leads to errors and omissions, with result that crucial step in process of care are forgotten or not to proceed. (Rawles 1997)

In addition, team approach is often inadequate, resulting in poor discharge planning and inadequate patient education. There is growing disenchantment among patients and their families are unaware of health care plan. Hospital staff are also unhappy with unplanned discharges. The challenge in health care today is to engineer effective use of shrinking resources and maintain or even increase quality outcomes in patient care. Clinical pathways or roads or paths critical care is one of those popular tool for managing disease that has recently been developed to address this problem. (Brett 1998)

Clinical pathways are essentially multidisciplinary management plans that show objectives for patients and provide corresponding ideal sequence and timing of interventions to achieve personal goals more effectively.

In U.S., clinical pathways have been increasing in popularity in part due to new government initiatives for health financing policy and application of case mix. Clinical pathways are considered case-mix tools to facilitate use of appropriate resources for homogeneous groups of patients (eg, within diagnosis-related group or DRG). (Schriefer 1995)

Clinical pathways - what, why, how

A clinical (or critical) pathway is an optimal sequence and timing of interventions by doctors, nurses and other health professionals for particular diagnosis or procedure, designed to minimize delays and maximize resource utilization and quality care. (Luttman 1995)

The often stated objectives of implementing clinical pathways typically are:

1. Selecting "best practice" when practice styles are known to differ significantly and unnecessarily.

2. Defining standards for expected duration of hospitalization and use of clinical tests and procedures.

3. examining relationships between different steps and stages in process of care and develop strategies to coordinate or decrease time spent in rate limiting steps.

4. Give all common objectives and personnel involved to understand their role in care process completely.

5. Provide framework for collecting and analyzing data on care process so that providers can understand how often and why patients do not follow an expected course during their hospitalization.

6. The decrease clinical documentation charges.

7. Improving patient satisfaction through improved patient education - for example, gives better attention ...