Erstellung und Implementierung eines Behandlungspfades zur Therapie von Frakturen der oberen Extremität bei Kindern und Jugendlichen bis 16 Jahren

BACKGROUND: The current health care climate demands a balanced provision of high quality patient care with simultaneous consideration of its cost effectiveness. Clinical pathways have been designed to provide an effective interface between evidence and practice in healthcare. Clinical pathways therefore define the essential components of care that are provided to patients with a specific diagnosis to achieve a desired outcome within a predetermined period. Development and implementation of clinical pathways based on national guidelines are effective means to streamline the provision of quality care in the most cost-effective manner. Operative care of children who contracted fractures of the upper extremities is a frequent pediatric surgical condition for which there is great variability among practitioners regarding diagnosis and prae,- and postoperative management. With this in mind, the authors designed and implemented an evidence-based clinical pathway for the operative care of children with fractures of the upper extremities. Therefore goals and key quality factors based on the affected guidelines for the standard of care were defined. Based on an actual analysis of 462 surgical reports, semistructured interviews with the involved medical and nursing staff and the analysis of barriers, literature and guideline research a target pathway was defined. The Modification of nationally developed guidelines via an integrative approach of various guidelines into one clinical pathway to realize standardization of operative care of children with fractures of the upper extremities and to eliminate unnecessary variation and repetition in resource usage was achieved. Furthermore barriers and facilitators for the implementation of these priority guidelines in clinician practice were identified by a coalition of medical directors and representatives of all occupational groups involved in inpatient healthcare in consensus process. Barriers to guideline implementation were identified by the clinicians regarding time, personal responsibilities, inconsistency among documentation issues and tools. Based on these identified room for improvement a clinical algorithm as quintessential key was developed and personal responsibilities and time limits were clearly assigned to each decision step and action. CONCLUSION: Implementing clinical guidelines at the local level requires a problem-oriented and management-oriented approach. Local consensus provided for the development and implementation of this modular concept of a clinical pathway for the operative care of children with fractures of the upper extremities. The pathway was finalised through a multi-tiered consensus process and adopted by the board of directors.