Clinical Pathway
Encyclopedia
Clinical pathways, also known as care pathways, critical pathways, integrated care pathways, or care maps, are one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. It has been proven that their implementation reduces the variability in clinical practice
and improves outcomes. Clinical pathways promote organized and efficient patient
care based on the evidence based practice. Clinical pathways optimize outcomes in the acute care and homecare settings.
Generally clinical pathways refer to medical guidelines. However a single pathway may refer to guidelines on several topics in a well specified context.
, USA) in 1985 inspired by Karen Zander and Kathleen Bower. Clinical pathways appeared as a result of the adaptation of the documents used in industrial quality management
, the Standard Operating Procedures (SOPs), whose goals are:
In April, 1991, VNA FIRST, in consultation with the Center for Case Management, Inc., South Natick, MA, developed the Home Health Care Map Tools (now called VNA FIRST Home Care Steps Protocols.)
In 2005, the telehealth clinical pathway was introduced to standardize telehealth visits and telephone calls in homecare.
thinking to the improvement of patient healthcare. An aim is to re-centre the focus on the patient's overall journey, rather than the contribution of each specialty or caring function independently. Instead, all are emphasised to be working together, in the same way as a cross-functional team
.
More than just a guideline or a protocol, a care pathway is typically crystallised in the development and use of a single all-encompassing bedside document, that will stand as an indicator of the care a patient is likely to be provided in the course of the pathway going forward; and ultimately as a single unified legal record of the care the patient has received, and the progress of their condition, as the pathway has been undertaken.
The pathway design tries to capture the foreseeable actions which will most commonly represent best practice for most patients most of the time, and include prompts for them at the appropriate time in the pathway document to ascertain whether they have been carried out, and whether results have been as expected. In this way results are recorded, and important questions and actions are not overlooked. However, pathways are typically not prescriptive; the patient's journey is an individual one, and an important part of the purpose of the pathway documents is to capture information on "variances", where due to circumstances or clinical judgment different actions have been taken, or different results unfolded. The combined variances for a sufficiently large population of patients are then analysed to identify important or systematic features, which can be used to improve the next iteration of the pathway.
Clinical Medicine
Clinical Medicine is a peer-reviewed medical journal published bimonthly by the Royal College of Physicians. It was established in 1966 as the Journal of the Royal College of Physicians of London. It was doubly named between 1998 and 2000, and since 2001 it has appeared as Clinical Medicine. Its...
and improves outcomes. Clinical pathways promote organized and efficient patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
care based on the evidence based practice. Clinical pathways optimize outcomes in the acute care and homecare settings.
Generally clinical pathways refer to medical guidelines. However a single pathway may refer to guidelines on several topics in a well specified context.
Definition of Clinical Pathway
Multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced either by hour (ED), day (acute care) or visit (homecare). Outcomes are tied to specific interventions.History
The clinical pathway concept appeared for the first time at the New England Medical Center (BostonBoston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
, USA) in 1985 inspired by Karen Zander and Kathleen Bower. Clinical pathways appeared as a result of the adaptation of the documents used in industrial quality management
Quality management
The term Quality management has a specific meaning within many business sectors. This specific definition, which does not aim to assure 'good quality' by the more general definition , can be considered to have four main components: quality planning, quality control, quality assurance and quality...
, the Standard Operating Procedures (SOPs), whose goals are:
- Improve efficiency in the use of resources.
- Finish work in a set time.
In April, 1991, VNA FIRST, in consultation with the Center for Case Management, Inc., South Natick, MA, developed the Home Health Care Map Tools (now called VNA FIRST Home Care Steps Protocols.)
In 2005, the telehealth clinical pathway was introduced to standardize telehealth visits and telephone calls in homecare.
Characteristics
Clinical pathways (integrated care pathways) can be seen as an application of process managementBusiness process
A business process or business method is a collection of related, structured activities or tasks that produce a specific service or product for a particular customer or customers...
thinking to the improvement of patient healthcare. An aim is to re-centre the focus on the patient's overall journey, rather than the contribution of each specialty or caring function independently. Instead, all are emphasised to be working together, in the same way as a cross-functional team
Cross-functional team
A cross-functional team is a group of people with different functional expertise working toward a common goal. It may include people from finance, marketing, operations, and human resources departments. Typically, it includes employees from all levels of an organization...
.
More than just a guideline or a protocol, a care pathway is typically crystallised in the development and use of a single all-encompassing bedside document, that will stand as an indicator of the care a patient is likely to be provided in the course of the pathway going forward; and ultimately as a single unified legal record of the care the patient has received, and the progress of their condition, as the pathway has been undertaken.
The pathway design tries to capture the foreseeable actions which will most commonly represent best practice for most patients most of the time, and include prompts for them at the appropriate time in the pathway document to ascertain whether they have been carried out, and whether results have been as expected. In this way results are recorded, and important questions and actions are not overlooked. However, pathways are typically not prescriptive; the patient's journey is an individual one, and an important part of the purpose of the pathway documents is to capture information on "variances", where due to circumstances or clinical judgment different actions have been taken, or different results unfolded. The combined variances for a sufficiently large population of patients are then analysed to identify important or systematic features, which can be used to improve the next iteration of the pathway.
Selection Criteria
The following signals may indicate that it may be useful to commit resources to establish and implement a clinical pathway for a particular condition:- Prevalent pathology within the care setting
- Pathology with a significant risk for patients
- Pathology with a high cost for the hospital
- Predictable clinical course
- Pathology well defined and that permits a homogeneous care
- Existence of recommendations of good practices or experts opinions
- Unexplained variability of care
- Possibility of obtaining professional agreement
- Multidisciplinary implementation
- Motivation by professionals to work on a specific condition
Examples
- Liverpool Care Pathway for the dying patient
- Depression in adults care map Map of Medicine, updated 30 July 2010
See also
- European Pathway AssociationEuropean Pathway AssociationThe European Pathway Association is a European non-profit organisation which brings together researchers, managers and clinicians on the management concept of clinical pathways...
(EPA) - Evidence-based medicineEvidence-based medicineEvidence-based medicine or evidence-based practice aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments and diagnostic tests...
- Nursing care planNursing care planA nursing care plan outlines the nursing care to be provided to an individual/family/community. It is a set of actions the nurse will implement to resolve/support nursing diagnoses identified by nursing assessment. The creation of the plan is an intermediate stage of the nursing process...
- Case managementCase managementCase management is a managed care technique within the health care coverage system of the United States.- Case management in health care :The Case Management Society of America, a non-profit association dedicated to the support and development of the profession of case management through...
- Health economicsHealth economicsHealth economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care...
External links
- European Pathway Association
- Belgian Dutch Clinical Pathway Network
- NHS Evidence Health Information Resources (UK)
- Map of Medicine
- About Integrated Care Pathways, NHS Protocols & Care Pathways Specialist Library (now discontinued). Version of 19 October 2007, via archive.org.
- http://www.scribd.com/Komite%20Medik (Indonesian)