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

Coma of unknown origin in the emergency department: implementation of an in-house management routine

“…For patients with multiple trauma, clinical pathways and structured education concepts such as ATLS ® are well established in most EDs. Implementation of clinical algorithms is feasible [ 15 , 16 ], shortens the time to diagnosis and treatment, and has been shown to significantly improve patient outcome [ 17 , 18 ]. Similarly, in common medical and neurological emergencies such as myocardial infarction [ 19 ] and stroke [ 20 ], clinical pathways and implemented algorithms accelerate clinical workflow and improve outcome [ 21 , 22 ].…”

How does the implementation of a patient pathway-based intervention in the acute care of blunt thoracic injury impact on patient outcomes? A systematic review of the literature

“…(2006) [19] Protocol group vs. control group (Median in years) 56 (IQR 51–65) vs. 60.5 ( 52 -72); p = 0.02 Protocol group vs. control group 63% ( n = 94) vs 65% ( n = 97); p = 0.72 Protocol group vs. control group Sternal Fracture: 10% ( n = 15) vs. 5% ( n = 8); p = 0.13 Pulmonary Contusion: 33% ( n = 50) vs. 37% ( n = 55); p = 0.55 Pneumothorax: 53% ( n = 79) vs. 39% ( n = 58); p = 0.01 Haemothorax: 43% ( n = 65) vs. 15% ( n = 22); p <0.0001 Protocol group vs. control group (Median no. of #) 6 (IQR 5–7) vs. 7 (IQR 6–9); p <0.0001 Protocol group vs. control group ISS: 21 (IQR 17–29) vs. 21 ( [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] ); p = 0.67 AIS Chest: 4 (IQR 3–4) vs. 4 ( [3] , [4] ), p = 0.17 Adrales et al. (2002) [28] Pre-protocol vs. Protocol group (Mean in years) 38.0 (±3.7) vs. 31.6 (±3.9); p = 0.08 Pre-protocol vs. Protocol group 71% ( n = 10/14) vs. 62% ( n = 29/47) Pre-protocol vs. Protocol group Blunt Thoracic Injury: 71% ( n = 10/14) vs. 57% ( n = 27/47) Motor Vehicle Collision: 50% ( n = 7/14) vs. 47% ( n = 22/47) Fall: 14% ( n = 2/14) vs. 9% ( n = 4/47) Assault: 7% ( n = 1/14) vs. 2% ( n = 1/47) Not Reported Pre-protocol vs. Protocol group 20.5 (±2.4) vs. 25.7 (±3.3); p = 0.33 Sesperez et al.…”

“…There was distinct variability in both the overall focus and individual components of the patient pathway-based interventions included in this study. The main focus areas of blunt thoracic injury care were identified as: analgesic management [16] , [17] , [18] , [19] , [20] , [21] ; respiratory care [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] ; surgical decision making (including chest drain management) [18 , [24] , [25] , [26] , [27] , [28] ; and reducing the risk of in-patient complications [ [16] , [17] , [18] , [19] , [20] , [21] , 29 , 30 ]. Outcome measures analysed in these studies included: Hospital Length of Stay; Intensive Care Unit Length of Stay; Rates of Pneumonia; Ventilatory support/respiratory function; Mortality; Thoracic Surgical Interventions; Analgesia; and Financial savings.…”

“…(2001) [21] (Mean in years) Pre-implementation: 41.6 (±20.5) Evaluation: 43.4 (±20.9) Re-evaluation: 39.9 (±20.7) p = 0.59 Pre-implementation: 69.7% Evaluation: 62.4% Re-evaluation: 70.5% p = 0.48 Allocation to Rib Fracture Pathway: Total: n = 87/265 Pre-implementation: n = 28 Evaluation: n = 38 Re-evaluation: n = 21 ( p = 0.07) Not Reported Pre-implementation: 12.7 (±11.5) Evaluation: 11.1 (±11.3) Re-evaluation: 11.1 (±9.9) p = 0.57 Wilson et al. (2001) [20] (Mean in years) 41.9 (±20.7) 65.8% ( n = 96) Allocation to Rib Fracture Pathway: Total: n = 59/146 Not Reported (Mean) 11.1 (±10.7) ISS BTI: 8.0 (±7.7) …”

“…Two studies analysed the provision of care through integrated care pathways which included a rib fracture management pathway [ 20 , 21 ]. In these studies, the pathway implementation was evaluated through measurement of the number of episodes of variance from the expected progress of patient recovery after injury.…”