Give your critical paths an annual checkup
Important to evaluate documents regularly
Question: How often should critical paths be updated and revised?
Answer: Critical paths should be evaluated for updates at least every year, advises Larry Strassner, MS, RN, CNA, project director for critical paths at The Johns Hopkins Hospital in Baltimore. You might even need to update even more frequently, depending upon the following issues:
• The volume of patients.
If you have low patient volume, you would revise paths less frequently; conversely, if you have high patient volume, you would probably need to revise critical paths more often than once a year.
• The kinds of variances you are finding.
If you are finding variances that may demonstrate system, patient, or practitioner issues and you note certain trends in variance data, your path may be wrong, or practitioners may need to make changes. You may also change your patient mix or find through variance data that your path isn’t appropriate for your patient population.
• New technologies or practices that are occurring.
For example, you may have introduced bedside testing to eliminate particular lab testing or a new procedure to shorten length of stay.
• New research information/literature that has become available.
That information may change the way care is being delivered.
• New products or drugs that have been introduced.
If you just have antibiotics listed on your critical path, then you may not need to revise it. That issue would depend on how detailed your critical path is. If you specifically identify a type of antibiotic or other medication and you change a practice related to it, then that path needs to be revised to reflect the new practice.
• Guidelines established by payers that have occurred.
If changes in case payment have happened, you may have to revise your pathway to support payment. For example, cataract surgery and mastectomy are moving toward reimbursement as outpatient procedures only; if your critical paths for those procedures are based on inpatient payment, they will have to be updated.
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