Heart failure (HF) is a major public health issue and acute decompensated heart failure (ADHF) is a leading cause of hospitalization in the USA. The United States health care delivery system is bound by regulatory agencies requiring strict compliance to key clinical indicators, which are publicly reported. Clinical pathway development is a systematic approach to managing health care that involves a high degree of collaboration between patients, physicians, nurses and various health-care team professionals. The University of California, Irvine Medical Center (UCIMC) developed an evidence-based multidisciplinary pathway for patients with ADHF. This clinical pathway incorporates universally proven assessment and treatment measures in ADHF. Adjunctive to this process are patient and nursing guides to the ADHF pathway. Utilization of this pathway has been shown to significantly impact clinical performance by early identification of potential negative clinical outcomes. Clinical pathways, such as the ADHF pathway, promote clinical excellence in caring for acute and chronic diseases states.

The total number of hip and knee arthroplasties has been increasing steadily in the USA every year. The University of California Irvine recognized a high volume activity that could be improved with the implementation of clinical pathways. Data collection was obtained by monitoring the clinical path on 138 patients. Baseline preoperative data and telephonic postoperative data were collected at 90 days postdischarge utilizing quality-of-life/functionality validated tools. Clinical path utilization was 100%. Ambulation day 1 was at 80% for hips and 85% for knees. Blood transfusions were at 56% for hips and 36% for knees. These percentages are well above the US national reported value for autologous blood transfusions of 30%.The short form 36 health survey questionnaire (SF-36) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) preoperative and postoperative data were available on 47 patients (35%) at 90 days. The WOMAC osteoarthritis index showed a percent mean difference improvement of 82% ( pre ¼ 35.8, post ¼ 65.3). The SF-36 revealed statistical significance in physical functioning, role physical, social functioning, bodily pain, energy/vitality and mental health. In conclusion, clinical pathways are a reliable measure of health care. Analysis of clinical path variance and functional outcomes provide the necessary data for making sound business/health-care decisions.

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