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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