Influence of a critical path management tool in the treatment of XXXX . Clinical Quality Improvement Network Investigators.

@entity1 @entity3362 @entity117 @entity460 @entity583 @entity1281
OBJECTIVE: The primary objective of this study was to determine the effect of implementing a critical path on use of proven efficacious therapies and outcomes in @entity1 admitted to a hospital with @entity583 ( @entity583 ). The secondary objectives were to evaluate the use of unproven medications and to develop an understanding of the factors associated with adverse in-hospital outcomes in these @entity1 . STUDY DESIGN: A nonrandomized before-after study design was used to evaluate the efficacy of a critical path instrument in @entity1 admitted to hospital with @entity583 . @entity1 AND METHODS: Consecutive @entity1 admitted with @entity583 in nine participating hospitals were enrolled in the study. The critical path instrument consisted of a locally developed, preprinted physician order form. Practice patterns were determined before (n = 2305) and after (n = 2349) implementation of the critical path by primary chart review. Multivariate analysis of risk factors for mortality was performed on a combined database of 6088 @entity583 @entity1 . RESULTS: The use of @entity117 ( @entity1281 ), @entity3362 , and beta blockers increased significantly by 3%, 2%, and 9%, respectively, after implementation of the critical path. Use of thrombolytics remained stable at 41%, and @entity460 channel blocker use decreased significantly by 8%. In-hospital mortality decreased by 1%. There was less use of @entity1281 , @entity3362 , beta blockers, and thrombolytic therapy in @entity1 and the elderly. Multivariate analysis showed that advanced age was associated with increased mortality risk, whereas @entity1281 , beta blockers, @entity3362 , and @entity460 channel blockers were associated with reduced mortality risk. CONCLUSION: Implementation of a critical path resulted in increased use of proven efficacious therapies, reduced use of noneffective therapy, and a trend toward reduced mortality.
