While nurses are expected to develop written care plans on all hospitalized patients, there are few studies of the relationship of this process to patient outcomes. The purpose of this research was to examine the effect of structuring the evaluation of subgoals, inherent in the critical pathway process, on outcomes achieved by patients with total hip or knee replacements. A critical pathway is a structured patient care plan that provides optimal sequencing and timing of interventions for a particular diagnosis or procedure, and the expected patient responses to those interventions.
The framework for this study was a conceptualization of the link between process and outcome in evaluating quality of care. The hypothesis was that patients whose care is planned and evaluated using a critical pathway will achieve better clinical outcomes; including greater self-care ability, ambulation, and lower psychological distress; a shorter hospital stay; and lower hospital charges than patients having care planned and evaluated according to the standard procedure.
The experimental group included 64 subjects recruited from the orthopedic unit at a 450-bed community hospital for comparison with data from a control group of 64 subjects recruited from the same site. A repeated measures, pre-test, post-test, quasi-experimental design was used. Data from the experimental group were collected on the first post-operative day and one day prior to discharge from the hospital as were the data from the control group. Post discharge data on the same patient outcomes were collected from a random sample from the experimental and control groups. Data analysis included bivariate analyses of group for similarities in sex, age, type of procedure, and multivariate analyses of each patient outcome variable.
Those participants with a critical pathway achieved better quality outcomes on the first post-operative evening and at discharge than did those with the traditional care planning process. The critical pathway group also experienced a shorter hospitalization. The charges for the critical pathway group were not significantly lower. The results of this study may provide valuable information regarding the design of the process for planning, evaluating, and documenting patient care, and directions for structuring the care planning and documentation process in on-line nursing information systems.
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