Successful incorporation of the Severe Head Injury Guidelines into a phased-outcome clinical pathway.

Clinical pathways have been proven to be valuable tools in improving outcomes in patients with neurological diagnoses. However, their use with trauma populations has been limited. The unpredictable nature of trauma makes it difficult to develop a day-by-day plan of care that would be applicable to all patients with the same trauma diagnosis. Nevertheless, a severe traumatic brain injury (TBI) clinical pathway was developed and implemented at a Level 1 Trauma Center with significant reductions in length of stay and number of ventilator days. With the publication of the Guidelines for the Management of Severe Head Injury, this pathway was refashioned into a severe TBI phased-outcome pathway. Rather than a day-by-day plan of care, this clinical pathway consists of four phases of care: (a) admission to the intensive care unit, (b) acute critical care, (c) mobility and weaning, and (d) pre-rehabilitation. After 12 months, the improvements accomplished by the original pathway have been maintained or exceeded.