Pathways

From HMCwiki

Clinical Pathways were introduced in the early 1990s in the UK and the USA, and are being increasingly used throughout the developed world. Clinical Pathways are structured, multidisciplinary plans of care designed to support the implementation of clinical guidelines and protocols. They are designed to support clinical management, clinical and non-clinical resource management, clinical audit and also financial management. They provide detailed guidance for each stage in the management of a patient (treatments, interventions etc. ....) with a specific condition over a given time period, and include progress and outcomes details.

Clinical Pathways aim to improve, in particular, the continuity and co-ordination of care across different disciplines and sectors.

Care Pathways can be viewed as algorithms in as much as they offer a flow chart format of the decisions to be made and the care to be provided for a given patient or patient group for a given condition in a step-wise sequence.

Clinical Pathways have four main components (Hill, 1994, Hill 1998): a time-line, the categories of care or activities and their interventions, intermediate and long term outcome criteria, and the variance record (to allow deviations to be documented and analyzed).

Clinical Pathways differ from practice guidelines, protocols and algorithms as they are utilized by a multidisciplinary team and have a focus on the quality and co-ordination of care.

Benefits

• Support the introduction of evidence-based medicine and use of clinical guidelines
• Support clinical effectiveness, risk management and clinical audit
• Improve multidisciplinary communication, teamwork and care planning
• Can support continuity and co-ordination of care across different clinical disciplines and sectors;
• Provide explicit and well-defined standards for care;
• Help reduce variations in patient care (by promoting standardization);
• Help improve clinical outcomes;
• Help improve and even reduce patient documentation
• Support training;
• Optimize the management of resources;
• Can help ensure quality of care and provide a means of continuous quality improvement;
• Support the implementation of continuous clinical audit in clinical practice
• Support the use of guidelines in clinical practice;
• Help empower patients;
• Help manage clinical risk;
• Help improve communications between different care sectors;
• Disseminate accepted standards of care;
• Provide a baseline for future initiatives;
• Not prescriptive: don't override clinical judgment;
• Expected to help reduce risk;
• Expected to help reduce costs by shortening hospital stays

Issues - potential problems and barriers to the introduction of ICPs

• May appear to discourage personalized care
• Risk increasing litigation
• Don't respond well to unexpected changes in a patient's condition
• Suit standard conditions better than unusual or unpredictable ones
• Require commitment from staff and Establishment of an adequate organizational structure
• Problems of introduction of new technology
• May take time to be accepted in the workplace
• Need to ensure variance and outcomes are properly recorded, audited and acted upon.