Managing Critical Pathway Variances

Abstract

As the use of critical pathways expands at an increasing rate, we are faced with the issue of how to manage variances from the pathway. Variance management is not clearly defined in the literature, and many institutions search for the best approach. We have implemented a number of different techniques for variance management at Fletcher Allen Health Care. Our success benefits both patients and providers.

Care pathways for acute stroke care and stroke rehabilitation: From theory to evidence

“…20,21 Variances represent the discrepancies between planned and actual events. They can also represent outcomes that differ from those anticipated or deviations from the projected timeline.…”

Variance analysis of a clinical pathway of video-assisted single lobectomy for lung cancer

“…2 The analysis of pathway variance is vital to achieving expected patient outcomes, the timely discharge of patients, and the appropriate utilization of resources. 8 The minute management of variance is important to maintain the quality of the clinical pathway and care. Our institution established a clinical pathway according to the Gantt chart from the beginning, and adopted a paper-based system for collecting date on variance.…”

“…Coffey et al reported that the timely analysis and management of variance from a critical pathway can bring about improvements in the form of fewer complications and less resource consumption. 8,9 Members of a multidisciplinary team review the charts at irregular intervals, collect data to analyze variances retrospectively, and strive to improve the management process; however, managing variance also requires ongoing perseverance and dedication, and it remains unclear how often teams should meet and what improvements need to be implemented. 8 According to clinical pathway maintenance, it is rarely discussed literally.…”

“…8,9 Members of a multidisciplinary team review the charts at irregular intervals, collect data to analyze variances retrospectively, and strive to improve the management process; however, managing variance also requires ongoing perseverance and dedication, and it remains unclear how often teams should meet and what improvements need to be implemented. 8 According to clinical pathway maintenance, it is rarely discussed literally. In fact, variances are rarely analyzed in health care organizations that have implemented clinical pathways because of the diffi culties in establishing defi nitions, identifying variance, and managing technology.…”

“…8 Through our experiences, a new type of all-in-one pathway was established as continuous, daily one-paged, and multi-paged foldouts with space left for pathway documentation alongside standard progress notes, which are shared with nurses' documentation. In addition, collecting variance with the gateway method 1 was implemented for ease of use and the early identifi cation of important critical conditions.…”