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Enhancing Patient Care Through Critical Pathways in Cardiology

Critical pathways are standardized treatment protocols developed to improve patient care and outcomes, particularly in the management of specific disorders in cardiology. By optimizing processes, preventing the underutilization of medications, and ensuring adherence to evidence-based guidelines, these pathways reduce hospital costs and minimize medical errors. They promote better communication between specialists and primary care providers, enhance patient compliance, and improve overall quality-of-care metrics. As emphasized by Sidney Smith, MD, implementing these pathways addresses the gap between evidence-based therapy and practical application.

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Enhancing Patient Care Through Critical Pathways in Cardiology

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  1. Quality Improvement Programs and Critical Pathways

  2. Why Develop Critical Pathways? “A treatment gap between therapy that is dictated by evidence-based medicine and therapy that occurs in practice is not a deficit of knowledge; rather, it is a deficit of implementation.” Sidney Smith, MDDirector, Center for Cardiovascular Science and Medicine, UNC School of Medicine

  3. Critical Pathways • Standardized treatment protocols for the management of specific disorders • Developed to optimize and streamline patient care • Prevent underutilization of medications, time in ICU/hospital, costs • Ensure quality-of-care measures (eg, door-to-drug times) • Optimize patient triage • Facilitate communication with specialists and PCP post-discharge • Enhance patient compliance and outcomes • Minimize potential for medical errors • Improve compliance with national standards (JCAHO) Adapted from: Cannon CP, O’Gara PT. Critical Pathways in Cardiology.Lippincott Williams & Wilkins; 2001.

  4. Joint Commission on Accreditationof Healthcare Organizations (JCAHO) • 1997: Launched ORYX™ to integrate use of outcomes and other performance measures into accreditation process • 2001: Announced 4 initial core measurement areas for hospitals (2 of 4 required): • Acute MI • Heart failure • Community-acquired pneumonia • Pregnancy • 2004: New accreditation process (“Shared Visions–New Pathways”) introduced. Hospitals previously collecting 2 of 4 measure sets are now required to collect 3 of 4 measure sets www.jcaho.org

  5. JCAHO Quality Measures in MI Hospitals graded on: • Antiplatelet therapy in AMI at arrival and discharge • b-blocker therapy at arrival and discharge • ACE inhibitor therapy for LVSD • Time to thrombolysis • Time to PCI • Adult smoking cessation counseling • Inpatient mortality www.jcaho.org

  6. Why a Hospital-Based System? • Patients • Patient capture point • Have patients/family attention: “teachable moment” • Predictor of care in community • Hospital structure • Standardized processes/protocols/orders/teams • JCAHO (ORYX and “Shared Visions – New Pathways”) Source: http://www.americanheart.org/getwiththeguidelines

  7. Practical Steps to Improve the Use of Evidence-Based Therapies for ACS • Develop critical pathways • Establish a multidisciplinary team approach (cardiology, ED, primary care, nursing, laboratory) • Identify local cardiology and ED “champions” • Track adherence to ACC/AHA guidelines • Develop educational materials to improve physicians’ knowledge of the guidelines • Secure institution’s commitment to improved patient care • Identify areas for continuous QI; provide QI tools • Elicit ongoing quarterly feedback Cannon CP, et al. Am Heart J. 2002;143:777-789.

  8. EMS Discharge Inpatient Critical Pathways Begin in Ambulance and Extend to Long-term, Office-based Care ED Community Adapted from Cannon CP, O’Gara PT. Critical Pathways in Cardiology.Lippincott Williams & Wilkins; 2001.Corbelli J, et al. Critical Pathways in Cardiology. 2003;2:71-87.

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