mined. For a larger, multispecialty facility, you may want to look at
your high-volume procedures with routine components, like orthope-
dics or cataract cases.
Once you've determined the specialty, study your current patient
population and its outcomes. Identify which patients have the best
outcomes and any common factors among them. Use this, plus input
from your medical director and other stakeholders, to define the crite-
ria. For example, for a patient to get on the outpatient total joint path-
way, he must have at-home support, no comorbidities and a relatively
routine operation planned.
2. Create the care pathway. Once you've identified the patients and spe-
cialty, it's time to look at each care component. Start by dividing up
the perioperative process — for example, pre-op, the OR and post-op
recovery. Then, identify the specific steps or treatments in each area.
Look at your patient outcome distribution curve for each of these
steps to determine what the gold standard is currently and how many
patients are meeting that goal. For example, when we looked at blad-
der catheter removal after cardiac surgery, we saw that the very best
we were doing was removing the catheter on the afternoon of the day
after surgery, which occurred in about 60% of patients. We then
researched best practices and quality measurements already in place,
and met with our physicians to discuss whether this was a realistic
expectation. Once everyone agreed, this goal for catheter removal
became part of our defined cardiac surgery pathway.
3. Communicate the care protocols. After determining these pathways, we
needed to communicate these protocols with bedside providers and
physicians, as well as clearly identify the patients who were to be
treated using the pathway. Whether you use EMRs or paper charts,
having clear communication is essential.
In our health IT system, patients who meet the threshold receive a
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