The role for public health in reducing iatrogenic patient injuries.

The authors argue that accidental patient deaths are a significant public health concern and that public health professionals are well positioned to contribute to ongoing efforts to protect the public from unintended injuries in the hospital.

Nursing performance measures go public.

Over 100 years ago, Florence Nightingale showed caregivers how to analyze mortality data to improve their clinical processes. The nurses of today are facing a new performance measurement challenge. Consumers of health care services want information that will help them compare quality among providers. This article describes the types of nursing performance measures most appropriate to include on these public-oriented report cards and several issues that influence report card design and dissemination.

Pathways to nowhere.

Early in the decade, health care discovered a powerful patient care management tool: the clinical path. Leaders in the field latched onto paths as the solution to cost and quality dilemmas, but they overlooked the importance of the underlying principles of quality management. Beyond Clinical Paths, a new book from American Hospital Publishing, focuses on the issues critical to successful quality improvement through clinical paths. The following excerpt by the book's editor, Patrice L. Spath, sets the stage for a new approach to clinical quality.

Guideline-based performance measurement creates education and training imperatives.

Clinical practice guidelines have introduced a new dimension to facility-level performance measurement--one which requires caregivers to change the way they have traditionally evaluated patient care practices. To successfully integrate guideline-derived evaluation tools into their performance measurement activities, practitioners and quality management professionals face new education and training challenges.

Path-based patient care should build quality into the process.

Clinical paths can help caregivers "do the right thing the first time" for the individual patient. They also can help to continually improve the system of providing care for future patients. By comparing what should be happening (according to the clinical path) with what actually is happening, the healthcare team can design an effective plan for patient care. By gathering data about the patient care experience, the healthcare team can redesign care for future patients. This article describes important concurrent and retrospective activities of path-based patient care and the ways in which healthcare providers are using clinical paths to improve patient outcomes.

Critical paths: maximizing patient care coordination.

1. With today's emphasis on horizontal and vertical integration of patient care services and the new initiatives prompted by these challenges, OR nurses are considering new methods for managing the perioperative period. One such method is the critical path. 2. A critical path defines an optimal sequencing and timing of interventions by physicians, nurses, and other staff members for a particular diagnosis or procedure, designed to better use resources, maximize quality of care, and minimize delays. 3. Hospitals implementing path-based patient care have reported cost reductions and improved team-work. Critical paths have been shown to reduce patient care costs by improving hospital efficiency, not merely by reducing physician practice variations.

The information imperative of outcomes management.

Health care providers are being asked to collect, analyze, and evaluate the results of medical processes or procedures to improve the outcome of health care services. The linkage of process to outcome is not a new science, but it has assumed greater importance in today's health care economic climate. Medical effectiveness and outcomes management studies, once within the purview of health services investigators, are moving to the individual provider setting. This evolution has tremendous impact on health information management professionals. As the guardians of the data that are indispensable for medical effectiveness and outcomes management investigations, health information management professionals play a key role in caregivers' attempts to correlate process and outcome performance measures. The article discusses the historical origins of outcomes management, the prominence of outcomes management in health care reform activities, and the responsibilities of health information management professionals in these strategic initiatives.