Physician champ helped gain acceptance of clinical pathway

Aim was to improve quality, reduce variations in care

A physician champion made all the difference when Methodist Medical Center (MMC) in Oak Ridge, TN, started its CareTrax clinical pathway system in 1993, says Coletta Manning, RN, MHA, CPHQ.

"We had a physician jump on the bandwagon right away and because of him, quickly got the other doctors on board. We have an excellent group of physicians who very rapidly understood that if we improve quality by reducing variation in the care, it made their job easier," adds Manning, the hospital’s director of clinical effectiveness and quality improvement.

She started her critical pathway initiative with total hip replacement patients, taking their charts and creating abstracts she put on a grid that documented the day-to-day care of each one.

For instance, in the case of one patient, she showed that the physician didn’t consult the discharge planner until the patient had been hospitalized for five days and that increased the length of stay.

In another case, Manning showed that the Foley catheter was left in four days instead of one because the physician forgot to write the order to remove it, and the patient got a urinary tract infection that kept him in the hospital longer.

She showed instances where the antibiotic that was prescribed was more expensive than one that was considered a standard of care and had the same effect.

"I showed them a lot of examples and asked if we could put the best practices together and have one physician try it to see how it works," Manning says.

The physician who did the highest volume in the group jumped at the chance to try the CareTrax.

"He had great outcomes and was the highest- volume producer and had very good results with the CareTrax. I took the idea to every department and soon had physicians asking for CareTrax for their departments," she continues.

When physicians told Manning that the CareTrax system was cookbook medicine and their patients were different, she had a ready answer. "I told them that I was sure they had a recipe in mind of all of the things they were going to do for every single one of their patients when they came into the hospital, and I wanted their recipe," she says.

Manning also attributes the success with the pathways to the fact that theirs is a stand-alone hospital and 99% of the physicians send all their patients to MMC. "They have a stake in it because they want us to stay open," she adds.

Manning has been at MMC for 29 years and has known many of the physicians for a long time.

"I came up through the ranks. I worked on the unit and have been in quality a long time, so there is an element of trust," she says.