The Evaluation of Clinical Pathway Implementation on Cerebral Infarction in the Inpatient Care Unit of Bantul X Hospital

Fitri, Duane Ayu; Sundari, Sri

doi:10.18196/jmmr.7268

Cited by 3 publications

(5 citation statements)

References 16 publications

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“…Periodic evaluation of the content provides the latest references for updates. 12 This study found that CP was implemented in 2019, but in practice, it did not work out.…”

Section: Discussionmentioning

confidence: 82%

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Unveiling quality, clinical, and financial Impacts of Pulmonary Tuberculosis Clinical Pathway Implementation in Magelang Public Hospital, Indonesia

Dhaniaputri,

Arini

2024

J Public Hlth Dev

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Tuberculosis (TB) is a popular endemic disease in Indonesia with increased risk outcomes. The clinical pathway (CP) is crucial to enhancing healthcare services and resource efficiency despite discrepancies in service variability reduction, clinical outcomes improvement, and cost saving. Therefore, this study aimed to assess pulmonary TB CP and evaluate its impacts on clinical and financial results, as well as barriers to implementation at Tidar Hospital in Magelang, Indonesia. A sequential explanatory mixed-method design was used from July 2022 to January 2023. The study began with a retrospective analysis of medical records of TB patients (total sampling, n=92). In-depth interviews (IDIs) were conducted with healthcare workers including the quality and medical committee, case manager, CP team, inpatient and non-inpatient nursing sub-coordinators, and pulmonary specialists. In addition, eight multidiscipline healthcare professionals attended the focus group discussions (FGDs). The audio recordings were transcripted verbatim and subjected to thematic analysis. The results showed that the quality and content of CP based on TB evaluation using the Integrated Clinical Pathway Assessment Tool (ICPAT) was 62.6%. Four themes were obtained: 1) CP implementation techniques, 2) supportive factors in the success of CP, 3) organization support in CP implementation, and 4) TB patient outcomes. Furthermore, procedure compliance after CP implementation was 33%. There were no significant differences in the length of stay (p=0.77), diagnosis investigation and therapy appropriateness (100%), mortality (4 vs 3 patients; p=0.589), and cost efficiency with an average cost of care (Rp 6.994.508,- vs Rp 5.521.091,-; p=0.083) before and after CP implementation. Readmission rates were low before and after deployment (1 vs. 2 patients). This study found no significant clinical or financial benefits in TB CP implementation. These results imply the need for hospital leadership and a multidisciplinary team to overcome CP implementation hurdles.

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“…Periodic evaluation of the content provides the latest references for updates. 12 This study found that CP was implemented in 2019, but in practice, it did not work out.…”

Section: Discussionmentioning

confidence: 82%

“…Safitri found that the hospital organized a CP drafting team that met periodically with outpatient and inpatient paramedics. 12 The major goal of the organization is to build solid commitments among healthcare professionals, including medical staff.…”

Section: Discussionmentioning

confidence: 99%

Unveiling quality, clinical, and financial Impacts of Pulmonary Tuberculosis Clinical Pathway Implementation in Magelang Public Hospital, Indonesia

Dhaniaputri,

Arini

2024

J Public Hlth Dev

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“…Other limitations in this study were that the provision of intervention to health workers was not directly to every healthcare practitioner but by seminars or CP material debriefs due to workplace protocols to mitigate and control the transmission of COVID-19. The limited social engagement aspect of this study's CP implementation towards healthcare practitioner may result in low adherence towards CP compliance, where adherence and compliance have been reported to be strongly associated [65,66]. Knowledge from CP intervention is often not always followed by behavioral changes, especially when pressure from external factors (egalitarianism, facilities, or systems) such as forcing the subject to change behavior [67,68].…”

Section: Limitations and Future Researchmentioning

confidence: 89%

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia

et al. 2022

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Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria.

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“…The most crucial goal in health care is beneficial outcomes for patients and communities. The desired outcomes depend on the quality of health or hospital services (Fitri and Sundari, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Besides, clinical process (clinical care) is regulated in medical service guidelines and the standards of nursing care or generally referred to as clinical guidelines. One of the clinical guidelines is the clinical pathway that has the potential to be used as a tool to guarantee and improve the quality of the clinical care process (Fitri and Sundari, 2018).…”

Section: Introductionmentioning

confidence: 99%

Resources Required in Clinical Pathway for Typhoid Fever Treatment at Kaliwates General Hospital in 2017

Dewi

Sandra

Witcahyo

2019

JAKI

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Background: A clinical pathway is a concept of an integrated service which describes the stages of healthcare services from the admission until the return of patients based on the medical service standards and evidence-based nursing care with measurable results. Kaliwates General Hospital is an accredited hospital with a clinical pathway. Typhoid case was the highest disease in 2017 at Kaliwates General Hospital.Aims: This study aims to describe the resources at Kaliwates General Hospital in the implementation of clinical pathways, especially typhoid fever treatment.Method: This study was a descriptive and qualitative study. Nine respondents were selected using purposive sampling, including one internist and the quality team at Kaliwates General Hospital. The variables studied include human resource factors, budget factors, method factors, and time factors.Results: The results suggested that the human resources at Kaliwates General Hospital had high commitment, motivation, and moderate knowledge in the implementation of clinical pathways. All equipment and documents were considered adequate. The communication among the implementers was good, but compliance and training for staffs were considered less prominent. The task division of each staff was fairly distributed even though the pharmacy unit perceived that the division was quite unfair.Conclusion: The implementation of the clinical pathway for typhoid fever treatment at Kaliwates General Hospital runs quite well. The hospital must identify and plan staff training regularly, prepare the job description appropriately, and perform performance appraisal based on the job description that has been developed.Keywords: clinical pathway, typhoid fever, resource.

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The Evaluation of Clinical Pathway Implementation on Cerebral Infarction in the Inpatient Care Unit of Bantul X Hospital

Cited by 3 publications

References 16 publications

Unveiling quality, clinical, and financial Impacts of Pulmonary Tuberculosis Clinical Pathway Implementation in Magelang Public Hospital, Indonesia

Unveiling quality, clinical, and financial Impacts of Pulmonary Tuberculosis Clinical Pathway Implementation in Magelang Public Hospital, Indonesia

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia

Resources Required in Clinical Pathway for Typhoid Fever Treatment at Kaliwates General Hospital in 2017

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