Paths provide a common ground for better practice
February 1, 1996
Paths provide a common ground for better practice
A team approach
Pathway development was put on the fast track when Mercy Hospital and Baptist Hospital merged in 1994 to form Mercy Baptist Health System in New Orleans.
The merger gave the two-hospital system an opportunity to get pathways off the ground quickly, says Tracey Moffatt, RN, BSN, director of utilization case management and social services at Mercy Regional Medical Center in Laredo, TX. Moffatt was promoted to her current position after serving as pathway project manager for Mercy Baptist in 1994 and 1995, while the merger was taking place.
Moffatt was pathway coordinator at Mercy Hospital when the merger was announced. After the merger was complete, Moffatt was appointed pathway project manager for both hospitals. She quickly appointed pathway coordinators at each campus to help establish a sense of teamwork and collaboration between both campuses.
Experience counts
Moffatt appointed nurses with several years of service from each hospital to promote physician and staff buy-in of pathway development projects at each campus. Pathway coordinators are responsible for creating development teams, providing pathway direction, handling problems that may occur during implementation, and meeting with the project manager weekly, says Moffatt.
Moffatt and the two pathway coordinators decided that the merger offered a good opportunity to introduce pathways, since the impetus for change already was in place. They set a goal of 20 paths for both hospitals to use. While Mercy had been using pathways before the merger, Baptist had not.
To begin path development, each coordinator collected statistical data from her respective campus to determine which paths should be developed. Atlanta-based HBO & Co. software that Baptist Hospital had before the merger was used for the data collection process, notes Moffatt.
Next, Moffatt and the two coordinators involved the cardiology, oncology, and diabetes clinical nurse specialists (CNSs) from each campus in team-building by assigning them research functions. The CNSs also encouraged pathway development by talking with physicians about the benefits of using critical paths. "We felt the CNSs would have better luck at talking with physicians than the coordinators," Moffatt adds.
Setting up the teams
Moffatt, both coordinators, and the CNSs then met to identify medical staff members for targeted path development teams at each facility. Each development team was presented with a first draft of a critical path developed by Moffatt, the coordinators, and the CNSs. "We invited medical staff from both campuses to attend meetings at either campus to help integrate the process. A pathway for [coronary artery bypass graft] was already in place at Mercy, so we presented that path as the first draft at Baptist," Moffatt explains.
Team members at Baptist quickly revised the pathway to adapt to their current practice patterns. Team members rewrote the path to incorporate a five-day length of stay (LOS), which had been six at Mercy, says Moffatt. "The Baptist team got the home health agency involved more on what the fourth-day post-op patient would need and actually wrote a better path," she adds.
Other teams wrote separate paths at each facility for other procedures, and Moffatt merged the two into a single document both facilities could use for each procedure. Mercy Baptist had implemented 13 paths by the time Moffatt was promoted later in 1995.
To ensure the new paths actually were being used, Moffatt and the coordinators met weekly to discuss implementation issues. "Writing the paths is easy, but implementing them is difficult. Constant use and evaluation is necessary. Correcting problems quickly also helped in compliance," Moffatt adds. *
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