The document discusses the concept of critical pathways in healthcare, which are management plans that outline expected outcomes and the timing of actions needed for efficient patient care. Developed from industry practices in the 1980s, critical pathways aim to standardize medical care, reduce costs, improve patient satisfaction, and facilitate communication among healthcare teams. Key features include multidisciplinary collaboration, structured plans, and the use of data to monitor and improve healthcare quality.

1. SEMINAR
On
CRITICAL PATHWAY
Mr Kulthe Vikrant R
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2. INTRODUCTION
Successful case management relies on critical
pathway to guide care. Critical pathway refers to the
expected outcomes and care strategies developed by
collaborative practice team. Critical pathways and health
care reforms are two separate entities. Critical pathways
are also known as critical paths, clinical pathways, or care
paths, are management plans that display goals for
patients and provide the sequences and timing of actions
necessary to achieve these goals with optimal efficiency.
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3. DEFINITION
 “Critical paths are guides that outline the critical or key events expected to happen each
day of patient’s hospitalization.”
--Cohen & Cesta,2001.
 “A critical pathway are management plans that display goals for patients and provide the
corresponding ideal sequences and timing of staff action to achieve those goals with
optimal efficiency.”
 “A critical pathway is an interdisciplinary plan of care that outlines the optimal
sequencing and timing of interventions for patients with a particular condition, procedure
and symptom’s.”
-- Ignatavicious &hausman, 1995.
 “A critical pathway is the sequence of events in a process that takes the greatest length
of time.”
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4. SYNONYMOUS
 Integrated Care, Pathways Multidisciplinary
pathways of care, Maps Collaborative Care,
Pathways Clinical pathway, Critical
pathway, Care track Care pathway
Anticipated recovery path Managed care
plans.
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5. HISTORY
The concept od critical pathways is borrowed from the
theories of Continuous Quality Improvement (CQI). Critical
pathways are first developed for the use in industry as a tool
to identify and manage the rate limiting steps in production
processes. In health care, critical pathways were first
developed and applied in 1980s to improve hospital
efficiency. Most of the first critical pathway in the hospital
are develop by nurses for nursing care alone. Later on these
have been developed by other disciplines covering all the
aspects.
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6. FEATURES
 Predetermined course of progress,
 Variance analysis,
 Fiscal planning,
 Directing,
 Orientation,
 Identifies outcome.
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7. GOALS OF CRITICAL PATHWAYS
 Selecting a best practice when practice style varies unnecessarily.
 Defining the standards for the expected duration of hospital stay and
for the use of tests and treatment.
 Examining the interrelations among the different steps in the care
process to find ways to co-ordinate or decrease the time in the rate-
limiting step.
 Giving all hospital staff a common game plan from which to view and
understand their various role in the overall care process.
 Providing a framework for the collecting data on the care process so
that providers can learn how often and why patients do not follow
an expected course during their hospitalization.
 Decreasing documentation burden.
 Improving patient satisfaction with care by educating patients and
their families about the plan of care.
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8. PURPOSES
 To monitor quality of patient care.
 To reduce variation in care, decreasing resource utilization and
potentially improve healthcare quality when used as a method.
 To achieved specified patient’s outcomes by a pre-set time
frame.
 To know the predetermine times frames for initiation of
treatment, generalized treatment protocols, and discharged
timelines for specific conditions.
 To shorten the hospital stay, more efficient use of resources,
more communication between discipline, and use of less
expensive method of treatment without compromising quality
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9. CHARACTERISTICS OF CRITICAL PATHWAYS
 It should be structured multidisciplinary care plan.
 It supports multidisciplinary care and evidence based clinical practice.
 The goal and key elements of care based on evidence and best practice
should be defined and stated.
 It should guide the management for a well-defined group of patients for a
well-defined period of time.
 It sequences the action of multidisciplinary team.
 It facilitates variance managements and allows documenting, monitoring and
evaluating the variance.
 The essential step in care of patients with specific clinical problem is
detailed.
 It should help communication with patient by providing a clearly summary of
care.
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10. BENEFITS OF CRITICAL PATHWAYS
 Improve patients care.
 Increase use of recommended medical acre.
 Decrease use of unnecessary tests.
 Decrease increase lengths of stay of patients.
 Reduce costs.
 Increase participation in clinical research
protocols.
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11. CONTAINS
 Specific medical diagnosis the expected length of stay Patient
identification data
Appropriate time frames (in days, hours, minutes or visits) for intervention
1. Patient outcomes
2. Interventions presented in modality groups (medications, nursing activity
& so on)
3. Nursing diagnosis.
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12. COMPONENTS
1.A timeline
1.The categories of care or activities
and their interventions
1.Intermediate and long-term outcome
criteria and the variance record.
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13. CRITICAL PATHWAY PROFESSIONAL
 Physician
 Nurse manager
 Staff nurse
 Social worker
 Dietician
 Occupational therapist
 pharmacist
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14. DEVELOP CRITICAL PATHWAY
 Retrospective chart review or concurrent chart review
 identify costs associated with the treatment
 Pathway development teams are organized to develop the
tool.
 Patient care expectations and critical events are identified for
incorporation into the path
 Small groups within the development to refine the elements of
the path
 Newly developed tools can be tested on previously admitted
patient
 Implementation with collaboration with other professionals
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15. Methods of Critical Pathway
 Critical path method is based on mathematical calculations
and it is used for scheduling project
 activities. This method was first introduced in 1950s as a joint
venture between Remington Rand Corporation and DuPont
Corporation.
 The initial critical path method was used for managing plant
maintenance projects. Although the original method was
developed for construction work, this method can be used for
any project where there are interdependent activities. In the
critical path method, the critical activities of a program or a
project are identified. These are the activities that have a
direct impact on the completion date of the project.
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17. Key Steps in Critical Path Method
Step 1: Activity specification
Step 2: Activity
sequence establishment
Step 3: Network diagram
Step 4: Estimates for each
activity
Step 5: Identification of the
critical path
Step 6: Critical path diagram to show
project progresses
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18. Step 1: Activity specification
 You can use the Work Breakdown Structure WBS to
identify the activities involved in the project. This is
the main input for the critical path method. In activity
specification, only the higher-level activities are
selected for critical path method. When detailed
activities are used, the critical path method may
become too complex to manage and maintain.
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19. Step 2: Activity sequence establishment
 In this step, the correct activity sequence is established.
For that, you need to ask three questions for each task of
your list.
 Which tasks should take place before this task happens?
 Which tasks should be completed at the same time as this
task?
 Which tasks should happen immediately after this task?
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20. Step 3: Network diagram
 Once the activity sequence is correctly identified, the
network diagram can be drawn
 Refertothesample diagram above. Although the early
diagrams were drawn on paper, there are a number of
computer softwares, such as Primavera, for this purpose
nowadays.
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21. Step 4: Estimates for each activity
 This could be a direct input from the WBS based
estimation sheet. Most of the companies use 3-
point estimation method or COCOMO based
function points based estimation methods for
tasks estimation. You can use such estimation
information for this step of the process.
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22. STEP 5: IDENTIFICATION OF THE CRITICAL PATH
For this, you need to determine four parameters of each activity of the network.
 Earliest start time ES - The earliest time an activity can start once the previous dependent
 activities are over.
 Earliest finish time EF - ES + activity duration.
 Latest finish time LF - The latest time an activity can finish without delaying the project.
 Latest start time LS - LF = activity duration.
 The float time for an activity is the time between the earliest ES and the latest LS start
time or
 between the earliest EF and latest LF finish times.
 During the float time, an activity can be delayed without delaying the project finish
date.The critical path is the longest path of the network diagram. The activities in the
critical path have an effect on the deadline of the project. If an activity of this path is
delayed, the project will be delayed. In case if the project management needs to
accelerate the project, the times for critical path activities should be reduced.
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23. STEP 6: CRITICAL PATH DIAGRAM TO SHOW
PROJECT PROGRESSES
 Critical path diagram is a live artefact. Therefore, this
diagram should be updated with actual
 values once the task is completed. This gives more
realistic figure for the deadline and the project
management can know whether they are on track
regarding the deliverables.
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25. ADVANTAGES OF CRITICAL PATH METHOD
Following are advantages of critical path methods:
 Offers a visual representation of the project activities.
 Presents the time to complete the tasks and the overall
project.
 Tracking of critical activities.
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26. CRITICAL PATHWAY ANALYSIS
 • Analyse the effectiveness
 • Variance analysis Positive variance Negative
variance
 • Consult with other professionals
 • Make change accordingly
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27. ROLE AS NURSE MANAGER:
 Assess quality improvement Effective planning
Evaluate quality Interdepartmental Communication
Educating the staff of other departments about the
pathway role and responsibilities.
 Provides patient care Follow critical pathway Inform
any deviance Collaborate with other professionals
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28. ADVANTAGES
 • Provides standardizing medical care for patients with
similar diagnosis
 • Use resources appropriate to the care needed
 • Reduce cost
 • Reduce length of stay
 • Improve the quality of care
 • Change practice pattern to increase efficiency
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29. DISADVANTAGES
Differences between unique patients One more paper work
Overburdened with administrative cost Problems of
introduction of new technology
• Require commitment from staff and establishment of an
adequate organizational structure
• May take time to be accepted in the workplace
• Need to ensure variance and outcomes are properly
recorded, audited and acted upon.
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30. CONCLUSION
Critical path identification is required for any project-
planning phase. This gives the project management the
correct completion date of the overall project and the
flexibility to float activities. A critical path diagram should
be constantly updated with actual information when the
project progresses in order to refine the activity
length/project duration predictions.
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