The summary in the table below includes a definition and an
overview of the history behind each of these initiatives for improving quality
and efficiency of care. Benchmarks are fairly new in health care, but are being
used extensively. Advanced Practice Nurses will be setting standards,
developing data or evidence-based pathways, using multidisciplinary guidelines
and researching comparative benchmarks. Read the table and then do the assignment.
For a sample benchmark table
comparing hospitals (published by KU
School of Nursing Advanced Practice Nurse graduates) click
here.
| Definitions and History | |
| Definitions | History |
|---|---|
| Standards of Practice include statements that represent performance of competent care that when provided by the professional should assure safe and efficacious care. Standards are developed by professionals and used in legal court cases. You will be held accountable for practicing according to your profession's standards. | Standards of Practice have been published for many years. Two types of standards have been developed, Standards of Professional Practice and Standards for Patient Care. The former provide overall statements for safe practice; the latter are, for effective care of patients' with specific needs. A multidisciplinary organization, The American Society for Parenternal and Enteral, (A.S.P.E.N.) has developed standards about nutrition care for dietitians, nurses, pharmacists, and physicians, as well as for home care, long-term care, pediatric, and hospitalized patients. |
| Clinical Pathways. Treatment regime, agreed upon by consensus, that includes all the elements of care across disciplines. Clinical pathways are broader and include all aspects of care, regardless of the effect on patient outcomes. These pathways often include laboratory tests and x-rays that do not affect patient recovery but are used to monitor care. Pathways are sometimes used to guide daily care. | Clinical Pathways have been in existence for at least 50 years. They arose from the need to give practitioners some guidance across disciplines on appropriate decision-making about health care for specific circumstances. The clinical or practice guidelines do include guidelines to assessment and care. These terms should not be used interchangeably, they are different. The JCAHO defines clinical pathways as basically road maps that include all the elements of care for a given disease. |
| Critical Pathways (JCAHO Definition) are treatment protocols, based on consensus of clinicians, that includes only those few vital components or items proved to affect patient outcomes. However, a component of care can be determined as vital (critical) either by omission or commission of the treatment or the timing of intervention. In addition, to JCAHO Definition, the critical pathway distinguishes the aspects of care that lend to efficient as well as effective care. | Critical Pathways have arisen as a result of the movement in health care toward standardizing care and outcomes-oriented approaches to treatment. A document published by A.S.P.E.N. which contains disease-specific guidelines is in the Journal of Parental and Enteral Nutrition 17(Suppl): 1SA-52SA, 1993. Critical paths are used in Home Care. Critical pathways are most effective guides when derived from research data. |
| Clinical (Practice) Guidelines. Systematically developed statements to assist practitioner and patients in determining appropriate health care for specific circumstances. Statements include the indications for doing a procedure or treatment and the accepted management of specific clinical problems. | Clinical (Practice) Guidelines: Many of these clinical or practice guidelines have been developed by National Institutes of Health, Agency for Health Care Practice Research. Some of the NIH guidelines are based on research done on outcomes of care. Most were developed by inter-disciplinary groups. |
| Benchmarks are descriptions of quality and costs of care provided in relationship to the resources and the expertise available. There may be numerous benchmarks on the same clinical topic (e.g. preemie care) which may vary by the characteristics of the organization where care is delivered. For example, the benchmarks for care of premature infants in rural small hospitals without neonatologists would emphasize appropriate emergency care and safe transport while the benchmarks for preemie care at level three nurseries would include preparing parents for home care. | Benchmarks have a long history in
business to guide appropriate comparisons.
Benchmarks are somewhat new but used frequently now in health care. However, as the example illustrates comparing outcomes from one agency to another or one service to another must consider the resources of each. |
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