Development and Implementation of Clinical Pathways in the CTICU AATS/STS Cardiothoracic Critical Care Symposium Sunday, May 5th, 2013 Rakesh C. Arora Co-Director – Intensive Care Cardiac Surgery Cardiac Sciences Program: University of Manitoba/ St. Boniface Hospital Disclosures Research Salary Support: Manitoba Health Research Council Manitoba Medical Service Foundation Development and Implementation of Clinical Pathways in the CTICU AATS/STS CARDIOTHORACIC CRITICAL CARE SYMPOSIUM – SUNDAY, MAY 5TH, 2013 RC ARORA CO-DIRECTOR – INTENSIVE CARE CARDIAC SURGERY CARDIAC SCIENCES PROGRAM: UNIVERSITY OF MANITOBA/ ST. BONIFACE HOSPITAL The Cardiac Critical Care Perspective Perspective The delivery of high-quality  critical care medicine is vital to the success of cardiac surgery BELLOMO, R. (2011). RECENT ADVANCES IN CRITICAL CARE MEDICINE RELEVANT TO CARDIAC SURGERY. HEART, LUNG & CIRCULATION, 20(3), 170–172. Evidence-based best practice  Participation in multicenter ICU  collaborations Employing state-of-the-art information  technology, (including point-of-care) Diagnostic testing  Efficient organization of ICU care  delivery Bauman, K. A., & Hyzy, R. C. (2012). Journal of Intensive Care Medicine. Outline What are clinical pathways  The Good, Bad and Indifferent  A “practical” example of implementing a new  clinical pathway What Happen? Case example  What we chose to do – Lean Transformation  How we did – The work plan and method of  implementation Does it work?  Lessons learned  What is a Clinical Pathway? a.k.a. Integrated Care Pathways,  Interdisciplinary Pathways of Care, Pathways of Care, Care Maps, Collaborative Care Pathways Essentially a patient care algorithm that  provides: flow chart format of the decisions to be made  a step-wise sequence  http://www.openclinical.org/clinicalpathways.html#benefits What is a clinical pathway? Clinical Pathways differ from practice  guidelines, protocols and algorithms as they are typically: utilized by an interdisciplinary team  focus on the quality and co-ordination of  care. What is unique about the CTICU? • High volume and high cost associated with cardiovascular 1. Who diseases and cardiac surgery Benefits? • Both “low-intensity” and “high- intensity” patients in the same environment • Can be used a method High-Risk • to reduce variation in care Low – Risk •Complex procedures • decrease resource utilization •Healthy •Multi-system • potentially improve healthcare •80% of patients issues quality •20% of patients Why Clinical Pathways are Necessary? Dissemination of information of accepted  protocols/guidelines makes little difference in clinical practice A CP provides the methodology to implement  guidelines