1. Clinical Management Nutr 564: Management Summer 2005

2. Clinical Management

3. Objectives: Review the functions of managementReview the functions of management Identify unique challenges of clinicalIdentify unique challenges of clinical management in nutrition/ dietetics Review Care PathwaysReview Care Pathways

4. 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?

5. Clinical Management Functions Plan Organize Direct Control

6. 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

7. Clinical Management Objectives: Review the functions of management Identify unique challenges of clinicalIdentify unique challenges of clinical management in nutrition/ dietetics Review Care Pathways

8. Clinical Management Challenges Organizational Structure Health Care Ancillary service

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

10. Clinical Management Objectives: Review the functions of management Identify unique challenges of clinical management in nutrition/ dietetics Review Care Pathways

11. Clinical Pathways

12. Also known as: Critical paths Critical pathways Care paths

13. 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 2000;101:461-5.

14. 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 1995;123:941-8.

15. 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 1995;123:941-8.

16. Clinical Pathways Care delivery tool similar diagnoses Identify level of care Members of Health Care Team Specifies time of intervention Incorporates discharge planning & education

17. Clinical Pathways Benefits Uniform care / reduces variation in care Improves communication Facilitates documentation Supports quality assurance efforts

18. 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

19. 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.

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

21. Clinical Pathways Examples: Information on patient’s nutritional care Admission: Screening - Baseline data - Ht, Wt, IBW, Nutritional Assessment - at risk statement During hospitalization: Interactions * Diet Instruction * Nutrition Support

22. Clinical Pathways Examples: Information on patient’s nutritional care Discharge Planning: Education Plan for follow-up

23. Concept Discussion From the reading by Sabo – what are your comments on the process that was used to develop their clinical pathway

24. 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