critical pathways

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    Has anyonw out there thought about the negatives of clinical paths ??? Are we encouraging cookbook medicine ?? Are the pathways designed to ensure all patient care is standardized ??? Or are they created so we can move patients quickly through the system in order to meet the DRG's ??? Are they good or are they detremental to individualized care for all patients ??
    What do you all think ???

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    Yes, yes, yes & yes in answer to your questions! I think that critical pathways were originally designed as a step toward improving the quality of care. By standardizing care in the form of critical pathways, we thought we could ensure that the right steps were taken for everyone. However, with the rapid changes in health care and the ensuing time constraints associated with the changes, patients have unfortunately become a series of checklists which must be completed before discharge. I think we need to rethink what we're doing to people. There is much emphasis these days on customer service issues and it's not too difficult to guess why. People want to be treated as the individuals they are instead of being lumped together as a diagnosis. I think once the power of human compassion becomes associated with better outcomes, there may be some new ways of making sure that care is more individualized again.
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    Hi there, interesting topic.
    I haven't been used to these pathways but at our hospital, we are in the process of developing some; (THJR, TKJR,) total abdominal hysterectomy, laparascopic chole, laparascopic appendectomy are being used in our surgical ward at the moment quite successfully.
    In answer to your questions;
    I don't see these as totally negative pathways,
    they are a standard pathway (obviously from research previously done) for a patient with the specific operation identified,
    the 'norm' would be the pathway,
    any variance is clearly documented and I see this as a really good way to research current trends, assess the variables and be able to put into effect, any change that may benefit the patient.
    Obviously the hospital trend, to 'save $$$'s
    is to reduce patient stay.
    I stayed in a maternity ward for eight days with my first born child 26 years ago.... admittedly, now, I believe we have gone the other way but.... look at the complications with long stay patients on bedrest....(talking surgical now)
    the perception of patients when they enter hospital (I have researched this one a little and enjoy this particular topic)I have watched elective surgical patients come into hospital and get straight into their PJ's or nightie on warding!!! Are they sick????
    Remember the sick role?
    Perhaps I am going on too musch, this topic opens up many doors and I would love to hear your reply and thoughts.
    Together, we all make for improved nursing through our communication.
    Cheers Karen.


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