Pearson S D, Lee T H, McCabe-Hassan S, Dorsey J L, Goldhaber S Z
Section for Clinical Epidemiology, Harvard Community Health Plan Division of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Am J Med. 1996 Mar;100(3):283-9. doi: 10.1016/S0002-9343(97)89486-7.
To address variation in treatment of deep vein thrombosis (DVT) while maximizing the efficiency and quality of care, our institution developed a critical pathway guideline. This paper presents this critical pathway and the clinical rationale underlying its recommendations. The DVT pathway synthesizes recommendations for all aspects of patient care, including laboratory evaluation at admission, dosing and management of heparin therapy, timing of warfarin initiation, elements of patient education, discharge planning, and anticipated duration of heparinization and hospitalization. Differences among interpretations of the medical literature, patient populations, physician skills, test availability, and other variables make it unlikely that all elements of this pathway would best meet the needs of another institution. Nevertheless, the critical pathway format and the specific contents of this pathway may serve as a useful benchmark for others involved in creating clinical guidelines for this patient population.
为应对深静脉血栓形成（DVT）治疗中的差异，同时最大限度提高医疗效率和质量，我们机构制定了一项关键路径指南。本文介绍了该关键路径及其建议背后的临床依据。DVT路径综合了患者护理各方面的建议，包括入院时的实验室评估、肝素治疗的剂量和管理、华法林起始时间、患者教育内容、出院计划以及肝素化和住院的预期时长。医学文献解读、患者群体、医生技能、检测可用性及其他变量存在差异，使得该路径的所有要素不太可能完全满足其他机构的需求。尽管如此，关键路径的形式及本路径的具体内容可为参与制定该患者群体临床指南的其他人提供有用的参考标准。
