Table 52.1. Key features of studies of critical pathways

Study SettingDesign, OutcomesClinical Outcomes (p value)Non-Clinical Outcomes (p value)
Children with an asthma exacerbation admitted to an academic medical center: patients randomized to pathway group or usual care group 22 Level 1,Level 1Shorter duration of intensive nebulizer treatment (0.02), length of stay (0.01)Lower room charges (0.001) and therapy charges (0.001)
Patients undergoing hip or knee replacement surgery at an academic medical center in Australia: patients randomized to pathway group or usual care group 21 Level 1,Level 1Shorter length of stay (0.011) and time to mobilization (0.001) and ambulation (0.02)
Patients being treated for hip fracture at an academic medical center in Australia 20 Level 1,Level 2Shorter length of stay (0.03)
Patients presenting to the emergency department with pneumonia at 19 medical centers across Canada: hospitals were randomized to pathway group or usual care group 23 Level 1,Level 1Lower rates of bed-days per patient (0.04), shorter length of stay (0.01) and shorter duration of IV therapy (0.01)
Patients in need of supplemental oxygen therapy: prospective before-after analysis with washout period 26 Level 2,Level 1More frequent appropriate oxygen discontinuation orders (0.001)Increased costs (0.02)
Patients undergoing unilateral neck dissection at an academic medical center: pathway group compared to historical controls and non-randomized concurrent controls 25 Level 2,Level 1Length of stay decreased compared to historical controls (0.001) but not concurrent controlsTotal costs decreased compared to historical controls (0.001) but not concurrent controls
Patients admitted to a community teaching hospital for the treatment of an asthma exacerbation: pathway group compared to historical controls and non-randomized concurrent controls 24 Level 2,Level 1More appropriate antibiotic use and conversion to nebulizer treatment (0.002 for historical controls, 0.05 for concurrent controls)
Patients undergoing one of several defined surgical procedures over a seven year period at an academic medical center: pathway group compared to historical controls as well as to patients from other similar hospitals in the same region 27 Level 2,Level 2Decreased lengths of stay for the pathway group compared to the historical controls, but not compared to the concurrent control group

From: 52, Critical Pathways

Cover of Making Health Care Safer
Making Health Care Safer: A Critical Analysis of Patient Safety Practices.
Evidence Reports/Technology Assessments, No. 43.
Shojania KG, Duncan BW, McDonald KM, et al., editors.

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