[From clinical guidelines to clinical pathways: development of a management-oriented algorithm for the treatment of polytraumatized patients in the acute period]

Abstract

Introduction: The treatment of polytraumatized patients in the acute period is an exemplary model of multidisciplinary cooperation in a very critical timeframe. Implementing standards formulated in the clinical guidelines of the German Association of Traumatology requires a detailed description of "how to do it."

Methods: Based on the guidelines and validated quality indictors, the optimal standard of care as the goal was defined. A clinical algorithm was developed and personal responsibilities and time limits were clearly assigned to each decision step and action. Checklists, documentation charts, and a full text supplement the algorithm. The complete pathway was adopted by representatives of all occupational groups involved in early trauma care in a consensus process.

Results: Improvement potentials were identified in those areas for which the guidelines did not provide explicit recommendations. These represent the key elements of the algorithm. Pathway-specific review criteria (quality indicators) were defined for scheduled reevaluation.

Conclusions: Implementing clinical guidelines at the local level requires a problem-oriented and management-oriented elaboration towards a clinical pathway as the basis for a quantitative process and cost analysis.