Algaze Claudia A, Shin Andrew Y, Nather Chealsea, Elgin Krisa H, Ramamoorthy Chandra, Kamra Komal, Kipps Alaina K, Yarlagadda Vamsi V, Mafla Monica M, Vashist Tanushree, Krawczeski Catherine D, Sharek Paul J
Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Palo Alto, Calif.
Center for Quality and Clinical Effectiveness, Lucile Packard Children's Hospital, Palo Alto, Calif.
Pediatr Qual Saf. 2018 Oct 31;3(6):e115. doi: 10.1097/pq9.0000000000000115. eCollection 2018 Nov-Dec.
Clinical effectiveness (CE) programs promote standardization to reduce unnecessary variation and improve healthcare value. Best practices for successful and sustainable CE programs remain in question. We developed and implemented our inaugural clinical pathway with the aim of incorporating lessons learned in the build of a CE program at our academic children's hospital.
The Lucile Packard Children's Hospital Stanford Heart Center and Center for Quality and Clinical Effectiveness partnered to develop and implement an inaugural clinical pathway. Project phases included team assembly, pathway development, implementation, monitoring and evaluation, and improvement. We ascertained Critical CE program elements by focus group discussion among a multidisciplinary panel of experts and key affected groups. Pre and postintervention compared outcomes included mechanical ventilation duration, cardiovascular intensive care unit, and total postoperative length of stay.
Twenty-seven of the 30 enrolled patients (90%) completed the pathway. There was a reduction in ventilator days (mean 1.0 + 0.5 versus 1.9 + 1.3 days; < 0.001), cardiovascular intensive care unit (mean 2.3 + 1.1 versus 4.6 + 2.1 days; < 0.001) and postoperative length of stay (mean 5.9 + 1.6 versus 7.9 + 2.7 days; < 0.001) compared with the preintervention period. Elements deemed critical included (1) project prioritization for maximal return on investment; (2) multidisciplinary involvement; (3) pathway focus on best practices, critical outcomes, and rate-limiting steps; (4) active and flexible implementation; and (5) continuous data-driven and transparent pathway iteration.
We identified multiple elements of successful pathway implementation, that we believe to be critical foundational elements of our CE program.
临床有效性（CE）项目旨在促进标准化，以减少不必要的差异并提高医疗保健价值。成功且可持续的CE项目的最佳实践仍存在疑问。我们制定并实施了首个临床路径，目的是汲取在我们学术儿童医院建立CE项目过程中的经验教训。
斯坦福大学露西尔·帕卡德儿童医院心脏中心与质量和临床有效性中心合作，制定并实施了首个临床路径。项目阶段包括团队组建、路径开发、实施、监测与评估以及改进。我们通过多学科专家小组和关键受影响群体的焦点小组讨论确定了关键的CE项目要素。干预前后比较的结果包括机械通气持续时间、心血管重症监护病房停留时间和术后总住院时间。
30名登记患者中有27名（90%）完成了该路径。与干预前相比，呼吸机使用天数减少（平均1.0±0.5天对1.9±1.3天；P<0.001），心血管重症监护病房停留时间减少（平均2.3±1.1天对4.6±2.1天；P<0.001），术后住院时间减少（平均5.9±1.6天对7.9±2.7天；P<0.001）。被视为关键的要素包括：（1）项目优先级以实现最大投资回报；（2）多学科参与；（3）路径关注最佳实践、关键结果和限速步骤；（4）积极灵活的实施；（5）持续的数据驱动和透明的路径迭代。
我们确定了成功实施路径的多个要素，我们认为这些要素是我们CE项目的关键基础要素。
