Maximize the efficiency of your patient pathways

When a surveyor from the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, asked case managers in the cardiac services department at Jewish Hospital in Cincinnati how it conducted patient education, the answer was — "I don’t know." Today the hospital is armed with patient education pathways for congestive heart failure (CHF), cardiac caths, angioplasty, and myocardial infarction.

"When surveyors asked us how we informed the patient about the course of their hospital stays, we really didn’t have a good answer," says Cathy Jenkins, RN, MS, CCRN, cardiology clinical nurse specialist. "We had books we could order from various places, but often they were too difficult for many patients to understand or too overwhelming. Who wants to read a book when you’re in the hospital?"

Patient education has become more difficult with shorter lengths of stay, notes Debra Caskey, RN, director of cardiovascular services. "It used to be patients came in the night before, and we could spend some time teaching them," she says. "Now there is less time to learn, which results in an increased anxiety level."

Jenkins accepted the challenge to develop a clinical pathway that would describe what most patients could expect from being hospitalized with CHF. The handout had to be brief but show how each discipline — including physicians, nursing, social work — would contribute to the patient’s total care. And it had to define clinical terms yet be easy to understand.

"Although we wanted it to cover as much of the continuum of care as possible, we didn’t want to overwhelm the patient with pages of information," Jenkins explains.

Jenkins launched the CHF pathway because that is her specialty, but shortly thereafter, "the project caught on." Three other nurses who needed a project for their clinical ladder wrote the others.

Although each pathway contains information specific to each, they all follow a standardized format that explains to family members what they can expect:

• before going to the hospital;

• during admission;

• during the procedure;

• after the procedure;

• after going home.

The pathways also contain a section for definition of related terms and a section on when to call the doctor or 911.

Although the pathways haven’t made their official debut yet — they’re in the final stages of production — managers of other service lines are scrambling to emulate the ones in cardiac services. (See pathways draft, pp. 205-206.)

Jenkins recommends the following steps in developing and implementing patient pathways:

1. Get physicians involved. "You need physician buy-in. If they don’t have a say in how it’s developed, they won’t use it," Jenkins says.

2. Form a task force. "We got off to such a quick start that later some people were asking us, 'Why didn’t we get a chance to review it?’" Jenkins says. "If I had it to do over again, I’d involve more people at the beginning."

3. Stress the interdisciplinary care team structure. "The pathway should address all disciplines — physician, nursing, social work — to give patients a sense of the scope of medical management," Jenkins says.

4. Define your terms carefully. "Clinicians may use a term like PTCA, but it not only needs to be defined for patients as percutaneous transluminal coronary angioplasty, but also defined as angioplasty," Jenkins says.

5. Keep it short and simple. Thinking like a patient — not a clinician — is key, adds Lisa McCormick, MSLS, AHIP, manager of the medical library.

That’s why McCormick encouraged cardiac services to create patient pathways on a sixth-grade reading level.

"Yes, it sounds low to us because we are surrounded by peers who are educated, but remember that illiteracy is prevalent in our society, particularly in areas with high immigration, poverty, and minority populations," she says.

6. Conduct a simple pilot study.

Jenkins showed a draft of the pathways to congestive heart failure patients. "One of them was a regular patient who was educated about his condition," she remembers. "When he read it, he surprised us by saying, ‘I didn’t know this.’"

That’s the kind of response the Joint Commission wants to hear.

[For more information on Jewish Hospital’s patient pathways, contact:

Cathy Jenkins, RN, MS, CCRN, cardiology clinical nurse specialist, Jewish Hospital, 3200 Burnet Ave., Cincinnati, OH 45229. Telephone: (513) 569-3586.]