Clinical Management

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Clinical Management

• Nutr 564 Management
• Summer 2005

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Clinical Management
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Clinical Management
Objectives Review the functions of
management Identify unique challenges of
clinical management in nutrition/
dietetics Review Care Pathways
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Concept Discussion

• Review the information in the Sullivan reading.
• Describe functions that may be unique to the
  manager of clinical nutrition services that may
  be difference from food service managers?
• What functions are similar?

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Clinical Management
Functions Plan Organize Direct Control
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Clinical Management
Acuity Decisions about acuity are based on
sensitivity and specificity models not on
universal principles. May be determined by
Diagnosis Screening Clinical Status
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Clinical Management
Objectives Review the functions of
management Identify unique challenges of
clinical management in nutrition/
dietetics Review Care Pathways
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Clinical Management
Challenges Organizational Structure Health
Care Ancillary service
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Concept Discussion

• Review the major topics we have covered this
  quarter and be prepared to discuss examples from
  clinical management.

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Clinical Management
Objectives Review the functions of
management Identify unique challenges of
clinical management in nutrition/
dietetics Review Care Pathways
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Clinical Pathways
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Clinical Pathways
Also known as Critical paths Critical
pathways Care paths
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Clinical Pathways
Management plans that display goals for patients
and provide the sequence and timing of actions
necessary to achieve these goals with optimal
efficiency Every NR et al. Circulation
2000101461-5.
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Clinical Pathways

• Select the best practice when practice varies
  unnecessarily
• Defining the standards for the expected
  duration of hospital stay and for the use of
  tests and treatment
• Examining the interrelations among the
  different steps in the care process to find
  ways to coordinate or decrease the time in the
  rate-limiting step
• Pearson SD, et al. Ann Intern Med 1995123941-8.

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Clinical Pathways

• Giving all hospital staff a common game plan
  from which to view and understand their various
  roles in the overall care process
• Providing a framework for collecting data on
  the care process so that providers can learn how
  often and why patients do not follow an
  expected course during their hospitalization
• Decreasing documentation burdens
• Improving patient satisfaction with care by
  educating patients and their families about the
  plan of care
• Pearson SD, et al. Ann Intern Med
  1995123941-8.

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Clinical Pathways
Care delivery tool similar diagnoses Identify
level of care Members of Health Care
Team Specifies time of intervention Incorporates
discharge planning education
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Clinical Pathways
Benefits Uniform care / reduces variation in
care Improves communication Facilitates
documentation Supports quality assurance efforts
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Clinical Pathways
Limitations Only useful if properly used in a
timely fashion Flexibility Often many of the
processes have not been tested Not all variation
is negative Not an end in itself Allow for
identification of problems
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Concept Discussion

• Review two of the care pathways linked to the
  schedule for Tuesday. Be prepared to comment on
  the following
• What information is present on the pathways that
  addresses nutrition issues?
• Can you determine which team member may chart
  this information?
• Are definitions provided on the indicators?
• Identify specific places on the care pathway
  where nutritional services would chart
  information.

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Concept Discussion

• Be prepared to discuss features of the care
  pathway that support information management, team
  communication and patient safety.

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Clinical Pathways
Examples Information on patients nutritional
care Admission Screening - Baseline data
- Ht, Wt, IBW, Nutritional Assessment - at
risk statement During hospitalization Intera
ctions Diet Instruction Nutrition
Support
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Clinical Pathways
Examples Information on patients nutritional
care Discharge Planning Education Plan for
follow-up
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Concept Discussion

• From the reading by Sabo what are your comments
  on the process that was used to develop their
  clinical pathway

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Clinical Pathways
Steps in developing a care pathway Select a
topic Select a team Evaluate the current
process of care Evaluate medical evidence and
current practice Determine the critical pathway
format Develop the algorithm Include
documentation on the pathway Document and
analyze variance Pathway implementation
Continuous Quality Improvement