Assessing the effectiveness of critical pathways on reducing resource utilization in the surgical intensive care unit

Objectives: To evaluate the effectiveness of procedure-specific surgical cr itical pathways on reducing resource utilization in a university surgical i ntensive care unit (ICU). Design and setting: Prospective cohort study in a university surgical ICU. Patients. 194 patients, accounting for 255 patient days, sampled on randoml y selected days over a 12-month period of time. Measurements and results: The primary outcomes of this study were pathway e ligibility and laboratory utilization. Patients were eligible for a procedu re-specific pathway in 34% of patient days identified, and the patient's cl inical course was "on" pathway in 22% of patient days. Of those "on" the pa thway, 54% had a pathway present in the chart and 32% of these included doc umentation of the patient's clinical course. Thus in 78% of the patient day s the patient was either not eligible for a critical pathway or the patient 's clinical course was "off" pathway. In those patients "on" the pathway 46 % did not have a pathway present in the chart. Being on a critical pathway did not reduce laboratory utilization. Laboratory utilization did not vary between patients "on" and "off" the pathway (19.1 +/- 11.3 laboratory tests /patient day versus 20.4 +/- 5.7 laboratory tests/patient day). Predicted l aboratory utilization by the pathway was 5.6 laboratory tests/patient day. By reducing actual laboratory utilization to that predicted by the critical pathway we would reduce laboratory utilization at our institution by $1.2 million per year. Conclusions: Procedure-specific surgical critical pathways are not an effec tive tool for reducing resource utilization in our ICU. Most of our patient s were not eligible for an available pathway, and those who were eligible a nd were "on" the pathway did not appear to have laboratory utilization guid ed by the pathway. Future initiatives need to explore other means such as I CU-specific care processes to reduce resource utilization in the ICU.