Grass Roots QI
February 1, 2000 2 minutes read
Grass Roots QI
Bronson Methodist Hospital piloted clinical pathways in 1995 in the neonatal intensive care unit. The goal was to test the cost and care effects at this 414-bed facility in Kalamazoo, MI. After a slow start, the benefits were clear, even to the skeptics, according to Jane Janssen, director of performance improvement and care management.
- IMPROVEMENT OPPORTUNITY
Pathways showed high potential for containing variable direct costs — "those that the physician’s pen can control," Janssen says. They include lab, X-rays, medical supplies, and room and board.
- Solutions
A multidisciplinary team selected DRGs for the clinical pathways trial. Their criteria were DRGs associated with high utilization or cost, established benchmarks for quality improvement, and physician interest. Selections were myocardial infarction, congestive heart failure, vaginal delivery, total hip replacement, pediatric pneumonia, and adult major trauma. The baseline improvement measure was DRG cost when a pathway went into use. Also tracked were procedure-to-ambulation and door-to-antibiotics cycles, as well as infection and mortality rates before and after pathways went into use. "You’ll always get physician resistance," Janssen notes. In this case, it was "What’s this, cookbook medicine?"
- RESULTS
Bronson Methodist currently uses more than 55 procedure-specific pathways. "Within the past three months, three physicians have come to me and asked for development of specific pathways!" Janssen notes. "Although I’d like to take credit for the $1.8 million we’ve saved since we started pathways," she adds, "other improvement initiatives have made an impact also." Pathways now form the nursing documentation framework, replacing care plans. Each discipline charts goals and outcomes on the pathways. Patients and families receive copies.
- Keys to success
1. Multidisciplinary input on each pathway makes all the difference between success or failure.
2. Regular feedback to the pathway team shows them the impact of their contribution.
3. Annual maintenance ensures pathway revisions as research advances.
- Contact
Jane Janssen, Director of Performance Improvement and Case Management, Bronson Methodist Hospital, Kalamazoo, MI. E-mail: [email protected].
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content