Premium
Using checklists and reminders in clinical pathways to improve hospital inpatient care
Author(s) -
Wolff Alan M,
Taylor Sally A,
McCabe Janette F
Publication year - 2004
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2004.tb06366.x
Subject(s) - medicine , clinical pathway , emergency department , emergency medicine , medical record , stroke (engine) , dysphagia , myocardial infarction , clinical practice , physical therapy , surgery , mechanical engineering , nursing , psychiatry , engineering
Objectives: To determine whether the quality of hospital inpatient care can be improved by using checklists and reminders in clinical pathways. Design: Comparison of key indicators before and after the introduction of clinical pathways incorporating daily checklists and reminders of best practice integrated into patient medical records. Setting and participants: The study, at Wimmera Base Hospital in Horsham, Victoria, included patients admitted between 1 January 1999 and 31 December 2002 with ST‐elevation acute myocardial infarction (AMI) and patients admitted between 31 July 1999 and 31 December 2002 with stroke. Main outcome measures: Compliance with key process measures determined as best practice for each clinical pathway. Results: 116 patients with AMI and 123 patients with stroke were included in the study.
ST‐elevation AMI . After introducing the clinical pathway program, percentage‐point increases for treatment compliance were 21.4% (95% CI, 7.3%–32.7%) for patients receiving aspirin in the emergency department; 42.7% (95% CI, 26.3%–59.0%) for eligible patients receiving β‐blockers within 24 h of admission; 48.1% (95% CI, 31.4%–64.8%) for eligible patients being prescribed β‐blockers on discharge; 43.7% (95% CI, 28.4%–59.1%) for patients having fasting lipid levels measured; and 41.2% (95% CI, 19.0%–63.5%) for eligible patients having lipid therapy.
Stroke . After introducing the clinical pathway program, percentage‐point increases for treatment compliance were 40.7% (95% CI, 21.0%–60.2%) for dysphagia screening within 24 h of admission; 55.4% (95% CI, 32.9%–77.9%) for patients with ischaemic stroke receiving aspirin or clopidogrel within 24 h of admission; and 52.4% (95% CI, 33.8%–70.9%) for patients having regular neurological observations during the first 48 h after a stroke. There was a fall of 1.0 percentage point (ie, a difference of –1% [95% CI, –4.7% to 10.0%]) in the proportion of patients having a computed tomography brain scan within 24 h of admission. Conclusion: Significant improvements in the quality of patient care can be achieved by incorporating checklists and reminders into clinical pathways.