Critical path method: an important tool for coordinating clinical care

In May 1991 Mount Clemens General Hospital (MCGH) began investigating the critical path method (CPM) as a tool for extending total quality management in clinical areas. In its search for guidelines on how to develop a critical path program, it found that other hospitals used a variety of approaches. These included employing case managers or outside consultants to develop programs or implementing prepurchased paths. Because these approaches often are difficult to customize for a specific institution and because MCGH wanted to use an internal team, none of these options seemed appropriate. With no definitive guidelines to follow, MCGH developed and implemented its own CPM.

The developmental process was composed of activities in nine primary categories: literature search, steering group, targeting strategy, paperwork design, gaining consensus, pilot program, preliminary findings, refine program, and full implementation.

A pilot was performed to assess if the CPM would be beneficial. Six months into the pilot a preliminary review of coronary artery bypass graft paths was conducted. There were 44 patients in the study group (35 men, 9 women). Twenty-four patients were cared for before the critical path form was available. Preliminary findings indicated a lower rate of complications in patients cared for with the critical path form. The data revealed a 5% complication rate with the critical path compared to a 16.6% rate for those whose care was not guided by the form. In addition, patients with the path on their clipboards had an overall shorter length of stay than patients without the path. It is important to remember that these early data are based on the six-month pilot; they are not considered a conclusive research finding.

The next step in the CPM process is to examine other diagnoses that might benefit from a critical path approach. A steering committee composed of representatives from hospital administration, nursing, medical staff, quality assurance and risk management, and total quality management will act as the approval body for investigating and sanctioning other paths for development.

The primary lesson learned at MCGH is that the CPM is most effective in an environment of communication and commitment. This approach allows clinic and nonclinic staff to talk about how their work influences each other's. CPM provides all caregivers with a common language and encourages everyone to look at the whole patient and the entire care process. The key message of success is: Get a group of people together who are motivated and empowered to move this exciting tool of the future through the necessary steps.