CLINICAL PATHWAYS CAN BE BASED ON ACUITY, NOT DIAGNOSIS

The standardization of medical practice is gaining acceptance as a tec hnique for controlling length of stay and hospital charges, while main taining quality. Most clinical pathways address specific diagnoses or procedures, but we have developed a new approach in which pathways for cardiac care are based on acuity. All congenital cardiac surgical car e rendered at Columbus Children's Hospital now falls within one of fou r such clinical pathways. This simplified approach is easy to use and has been well accepted. Our experience in a group of 107 consecutive p atients treated in this fashion is described. The results of variance analyses, along with length of stay and charge data, are presented to demonstrate the degree to which resource utilization can be standardiz ed in this widely variable group of patients whose problems were made cohesive by classification according to acuity level. We conclude that the resultant standardization offers considerable advantages for the managed care environment.