Critical Pathways
Critical pathways have varying formats and are known by many names, including
critical paths, clinical pathways, and care paths. Interpreted formally, a critical pathway
is the sequence of events in a process that takes the greatest length of time. Like the
techniques of continuous quality improvement, critical pathway techniques were first
developed for use in industry as a tool to identify and manage the rate-limiting steps in
production processes.
Critical pathways were first developed and applied to health care in the 1980s,
when prospective payment systems focused greater interest on potential methods to
improve hospital efficiency. Most of the first critical pathways in hospitals were
developed by nurses for nursing care alone, but multidisciplinary teams soon began
developing pathways to encompass all aspects of care for hospitalized patients.
In general, efforts to develop critical pathways in health care have not
incorporated the formal techniques used by industrial predecessors to identify the true
"critical" pathway in any care process. Instead, when critical pathways are used to plan
medical care, the specific goals usually include the following:
1. Selecting a "best practice" when practice styles vary unnecessarily.
2. Defining standards for the expected duration of hospital stay and for the use of
tests and treatments.
3. Examining the interrelations among the different steps in the care process to
find ways to coordinate or decrease the time spent in the rate-limiting steps.
4. Giving all hospital staff a common "game plan" from which to view and
understand their various roles in the overall care process.
5. Providing a framework for collecting data on the care process so that
providers can learn how often and why patients do not follow an expected course during
their hospitalization.
6. Decreasing nursing and physician documentation burdens.
7. Improving patient satisfaction with care by educating patients and their
families about the plan of care and involving them more fully in its implementation.
As a potential tool of quality improvement, critical pathways have tremendous
appeal because of their multidisciplinary methods, their focus on process and on
reducing unnecessary variation, and their attention to patient outcomes all in a package
that also offers a tangible way to reduce the duration of hospital stays and resource use.
However, despite the appealing logic of this approach to quality improvement, serious
concerns and questions remain about the development, implementation, and costs of
critical pathways, as well as about their true potential to reduce costs or improve quality.
While future research is pursued, critical pathway programs are in place today,
affecting the care of thousands of patients daily. An important current challenge for
physicians is to participate in pathway development and implementation so that the
management protocols reflect their beliefs about care. Although critical pathways clearly
hold the promise of reduced costs and improved quality, the fulfillment of this promise
requires the full and informed participation of physicians.
E-Journals
Electronic journals are scholarly publications that are published online. E-journals
are also called online journals, virtual journals, digital journals and zines or e-zines. E
journals are very convenient because information is at your fingertips. There are also
value-added features such as search facilities, other links, video, graphics, audio and
dictionary.
Advantages of E-journals are the following:
1. Simultaneous access
2. Links to related items
3. Ease of downloading
4. Wider dissemination of journal/research
5. Alert services
6. Eliminates physical processing
7. Save shelve space
8. Access anytime, anywhere
9. First published online – available quicker than print publications
10. Access to archive issues
But also E-journals have disadvantages such as:
1. Technical barriers – hardware, software and network connection
2. Infrastructure snags – bandwidth and load shedding issues
3. Require skills and training to use
4. Costs to acquire e-resources can be high-technology and content
5. User unfriendliness depends on platform
