Critical Pathway Effectiveness: Assessing the Impact of Patient, Hospital Care, and Pathway Characteristics Using Qualitative Comparative Analysis

The purpose of this paper is to qualitatively describe patient, hospital care, and critical pathway characteristics that may be associated with pathway effectiveness in reducing length of stay. Administrative data and review of pathway documentation and a sample of medical records for each of 26 surgical critical pathways in a tertiary care center's department of surgery, 1988-1998, were studied. All 7 of the 26 pathways associated with a reduced length of stay had at least one of the following characteristics: 1. no preexisting trend toward lower length of stay for the procedure, and/or 2. it was the first pathway implemented in its surgical service. In addition, pathways effective in reducing length of stay tended to be for procedures with lower patient severity of illness, as indicated by fewer intensive care days and lower mortality. Effective pathways tended to be used more frequently than ineffective pathways, but high rates of documented pathway use were not necessary for pathway effectiveness.