Using checklists and reminders in clinical pathways to improve hospital inpatient care

Alan M Wolff, Sally A Taylor and Janette F McCabe
Med J Aust 2004; 181 (8): 428-431.


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 β-blockers within 24 h of admission; 48.1% (95% CI, 31.4%–64.8%) for eligible patients being prescribed β-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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  • Alan M Wolff1
  • Sally A Taylor2
  • Janette F McCabe3

  • Clinical Risk Management Unit, Wimmera Health Care Group, Horsham, VIC.



We wish to thank the staff and board of management of the Wimmera Health Care Group for their continued support and participation in the program. We also thank Professor Edward Janus, Visiting Physician, and Mr Ian Campbell, Visiting Surgeon, for their valued participation in developing and promoting clinical pathways and in reviewing our manuscript.

Competing interests:

Our study was supported by the Victorian Managed Insurance Authority and the Victorian Department of Human Services through their Designing Care initiative. These funding sources had no role in the study design, data collection, analysis and interpretation, or in writing this article.

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