Clinical pathways: A special report

Enhance pathways to make patient central focus

VUMC’s pathway care adds unique dimensions

In a unique approach to acute pathway-based care, Vanderbilt University Medical Center (VUMC) in Nashville, TN, has put important "addendums" in its pathway collection. Besides the typical clinical guidelines for care, Vanderbilt case management uses order sets and guidelines for things such as spiritual needs, spiritual distress, and specific age-related issues, all of which can be part of almost any illness or procedure.

These "overlays," as Irene Hatcher, MSN, RNC, coordinator of case management and clinical pathway development, calls them, can be paired with any diagnosis or treatment-related pathway. "Probably the best way to apply a spiritual needs path would be if the hospital has an electronic system capable of merging or overlaying paths, such as the Pathworx System in use at VUMC. A Spiritual Needs Set has been developed, which can be overlaid’ on any disease or procedure pathway," she says. "There is certainly evidence out there that shows that patients who are in spiritual distress really do not do as well, clinically," she notes.

VUMC’s electronic order set system, Pathworx, was developed in-house, but other programs can accomplish similar results. With less time spent on pen-and-paper records, nurses are free to really care for patients, including their spiritual needs, or for example, specific needs they might have as patients over age 75. "You can have the pathway for instance, for appendectomy, and then you bring the Above Age 75 Set to it; it makes the appendectomy pathway for a 16-year-old and a 76-year-old look very different," she says, and more appropriate to each patient as an individual.

VUMC has not yet collected any of its own evidence to prove that addressing these additional needs cuts length of stay or produces better outcomes, because outcomes are being measured within the original diagnosis, not the additional order set.

"Quite frankly, we’re just now putting it into a set and trying to make it more user-friendly." But Hatcher anticipates that, in addition to creating better outcomes for the hospital, her brand of pathway usage will truly create better care.

[For more information, contact:

Irene Hatcher, MSN, RNC, Coordinator of Case Management and Clinical Pathway Development, Vanderbilt University Medical Center, 1161 21st Ave. S., A-1202 MCN, Nashville, TN 37232-2415. Telephone: (615) 343-2680.]