Clinical pathways - can they be used in trauma care. An analysis of their ability to fit the patient

This study prospectively evaluated the appropriateness and ability of clini cal pathways to fit trauma patients in five key conditions, severe head inj ury, fractured ribs, fractured pelvis, fractured femur and blunt abdominal trauma, who were admitted to a single Level 1 Trauma Centre, between Februa ry and July 1999. Each pathway consisted of 14 elements of care divided int o observable outcomes. Failure to achieve an outcome resulted in a variance or deviation from the pathway, which was assessed by the number of non-app licable variances. Appropriateness of clinical pathways was assessed by the applicability index (the number of non-applicable variances divided by the potential variances). Critical mismatches occurred when non-applicable var iances exceeded 50% of potential variances. 146 patients, with the mean age 41.9 years (S.D. 20.7), mean ISS 11.1 (S.D. 10.7) were enrolled; 18 with s evere head injury, 59 with fractured ribs, 13 with fractured pelvis, 20 wit h fractured femur and 36 with blunt abdominal trauma. Critical mismatch occ urred in seven patients. Applicability indexes were 87 for head, 93 for rib s, 92 for blunt abdominal trauma, 91 for femur and 92 for the pelvic pathwa y. Patient assessment, pain management, skin integrity and patient educatio n were the most appropriate key elements of care, discharge planning, patie nt satisfaction, treatment and activity were least applicable. This study i dentified, for the first time, that clinical pathways are clinically approp riate for major trauma conditions. (C) 2001 Elsevier Science Ltd. All right s reserved.