[Evaluation of a clinical pathway for septic arthritis].
BACKGROUND
Clinical pathways are tools that coordinate clinical work, reducing interclinican variability and improving patient care and management. The use of clinical pathways in septic arthritis is appropriate, as this disease has a predictable course and there is considerable variation in its management. The aim of this study was to evaluate a septic arthritis clinical pathway 2 years after its introduction and to describe the characteristics of the patients included.


METHODS
Clinical pathway documents: pathway matrix sheet, variance form, parent information sheet, satisfaction survey and evaluation indicators sheet.


RESULTS
Thirty-five patients were included, seven with a definitive diagnosis of septic arthritis and 28 with probable septic arthritis. No differences were found between the two groups, with good outcomes in both. Laboratory analyses were performed at admission in all patients, at discharge in 51 %, and at the end of treatment in 97 %. The indicators that best met the standard were clinical pathway coverage, performance of arthrocentesis/arthrotomy, and satisfaction with dealings with staff and the information received. The indicators furthest from the standard were admission shorter than 7 days (77 % vs > 95 %) and obtaining articular fluid prior to antibiotic therapy (76 % vs > 90 %).


CONCLUSIONS
The clinical pathway is useful for standardizing the process of septic arthritis diagnosis and treatment. With adequate clinical support, application of this pathway allows decisions to be made on hospital discharge following the clinical criteria of improvement without worsening prognosis. Our immediate challenges are to reduce inpatient stay and to obtain synovial fluid before starting antibiotic therapy.
Sección de Reumatología Pediátrica, Hospital Universitario La Paz, Madrid, España. rmerino.hulp@salud.madrid.org
R
R
Merino Muñoz
A
A
Martín Vega
J
J
García Caballero
J
J
García-Consuegra Molina
D001170:Arthritis, Infectious / Q000188:drug therapy* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male