Hospital case management : the monthly update on hospital-based care planning and critical paths
-
By implementing an innovative set of ventilator protocols, case managers at Nash General Hospital in Rocky Mount, NC, have cut length of stay for ventilator patients by 34%, reduced the average duration of mechanical ventilation by 38%, and saved the hospital an average of $35,000 in charges per ventilator patient. Elements of the protocol include using pulse oximetry in place of autologous blood gases when possible, performing a chest X-ray and initiating tube feeding immediately after the patient is placed on the ventilator, taking sputum cultures to determine a baseline for organism growth and the need for antibiotics, and weaning the patient at certain oxygen levels. Ventilator collaborative team members are also examining the possibility of adding a kinetic therapy element to the protocols.
-
With today's emphasis on horizontal and vertical integration of patient care services, caregivers are turning to clinical pathways to more effectively manage perioperative patients. Often, such pathways are generic (covering, for instance, all orthopedic or all vascular procedures). Such paths are especially helpful for organizations wishing to use the path for documentation purposes. In developing perioperative pathways, identify the specific patient care outcomes to be achieved; review patient records, nursing practice standards, and other materials to identify the common elements of care; and decide upon a process for reporting variances.