| Using checklists and reminders in clinical pathways to improve hospital inpatient care. | |
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MedLine Citation:
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PMID: 15487958 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To determine whether the quality of hospital inpatient care can be improved by using checklists and reminders in clinical pathways. DESIGN: Comparison of key indicators before and after the introduction of clinical pathways incorporating daily checklists and reminders of best practice integrated into patient medical records. SETTING AND PARTICIPANTS: The study, at Wimmera Base Hospital in Horsham, Victoria, included patients admitted between 1 January 1999 and 31 December 2002 with ST-elevation acute myocardial infarction (AMI) and patients admitted between 31 July 1999 and 31 December 2002 with stroke. MAIN OUTCOME MEASURES: Compliance with key process measures determined as best practice for each clinical pathway. RESULTS: 116 patients with AMI and 123 patients with stroke were included in the study. ST-elevation AMI. After introducing the clinical pathway program, percentage-point increases for treatment compliance were 21.4% (95% CI, 7.3%-32.7%) for patients receiving aspirin in the emergency department; 42.7% (95% CI, 26.3%-59.0%) for eligible patients receiving beta-blockers within 24 h of admission; 48.1% (95% CI, 31.4%-64.8%) for eligible patients being prescribed beta-blockers on discharge; 43.7% (95% CI, 28.4%-59.1%) for patients having fasting lipid levels measured; and 41.2% (95% CI, 19.0%-63.5%) for eligible patients having lipid therapy. Stroke. After introducing the clinical pathway program, percentage-point increases for treatment compliance were 40.7% (95% CI, 21.0%-60.2%) for dysphagia screening within 24 h of admission; 55.4% (95% CI, 32.9%-77.9%) for patients with ischaemic stroke receiving aspirin or clopidogrel within 24 h of admission; and 52.4% (95% CI, 33.8%-70.9%) for patients having regular neurological observations during the first 48 h after a stroke. There was a fall of 1.0 percentage point (ie, a difference of -1% [95% CI, -4.7% to 10.0%]) in the proportion of patients having a computed tomography brain scan within 24 h of admission. CONCLUSION: Significant improvements in the quality of patient care can be achieved by incorporating checklists and reminders into clinical pathways. |
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Authors:
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Alan M Wolff; Sally A Taylor; Janette F McCabe |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: The Medical journal of Australia Volume: 181 ISSN: 0025-729X ISO Abbreviation: Med. J. Aust. Publication Date: 2004 Oct |
Date Detail:
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Created Date: 2004-10-18 Completed Date: 2005-01-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0400714 Medline TA: Med J Aust Country: Australia |
Other Details:
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Languages: eng Pagination: 428-31 Citation Subset: IM |
Affiliation:
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Clinical Risk Management Unit, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, Australia. Alan.Wolff@whcg.org.au |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Critical Pathways* Follow-Up Studies Guideline Adherence / statistics & numerical data* Hospitalization / statistics & numerical data* Humans Myocardial Infarction / therapy Outcome Assessment (Health Care) Quality Assurance, Health Care / methods* Reminder Systems* Victoria |
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