Clinical Pathways: multidisciplinary plans of best clinical practice.
Clinical Pathways are structured, multidisplinary plans of care designed to support the implementation of clinical guidelines and protocols.
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 timeline, 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 analysed).
- Support the introduction of evidence-based medicine (循证医学) 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 standardisation);
- Support training;
- May appear to discourage personalised 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 establishement of an adequate organisational structure
- Problems of introduction of new technology
- Need to ensure variance and outcomes are properly recorded, audited and acted upon.
ICP: Integrated care pathways.