Journal if 95

REVIEW ARTICLE

Effects of clinical pathways: do they work?

P Van Herck, K Vanhaecht and W Sermeus
Centrefor Health Services and Nursing Research, School (:(Public Health, Catholic University Leuven, Be(rsiu111

ABSTRACT. Objective: Evaluation of the effect of implementing clinical pathways is a relatively new field
in health care research. Little is known about the way in which practice is influenced by the implementa-
tion of clinical pathways, and to what degree. This review takes significant steps in answering these ques-
tions by describing the parameters that are used in literature as indicators to evaluate clinical pathways.
Methods: A Medline-based review of literature published between 2000 and 2002 was carried out using
the keywords' clinical pathway', 'critical pathway', 'care map', 'care pathway' and 'integrated care pathway'.
Articles were selected if they contained any form of evaluation, outcome or indicator concerning the use
of clinical pathways. This included all types of research design and sample size. A total of 200 articles -.vere
selected. Relevant data were summarized using the following characteristics: country of origin, clinical
field of expertise, research design, sample size, clinical outcome indicators, service indicators, team indica-
tors, process indicators and financial indicators. For each domain a positive, negative or 'no effect' conclu-
sion was recorded. Excel® and Statistica® were used to obtain percentages and graphics. Results: A total of
34% of the articles on clinical pathways contained some form of evaluation concerning the effect ol the
implementation. Out of these articles, clinical outcome was emphasized in 65.5%, financial effects in 63%)
and process effects were investigated by 50% of the studies. Team and service effects were discussed less
often (24% and 18.5%), respectively). For clinical outcome, team, process and financial effects a variet y of
indicators were recorded. Service effects were almost always measured as 'patient satisfaction'. The majority
of the literature concluded that positive effects result from the implementation of clinical pathv ·ays.
Conclusion: On a macro level clinical pathways result globally in positive effects. Negative results, however,
were also present in the literature. In particular for process, team and service evaluation concerning the use
of clinical pathways there is still a great need for research.

INTRODUCTION 'a collection of methods and means to help the mul-

tidisciplinary and interprofessional team towar is col-
The use of clinical pathways is becoming more and
laboration for a specific patient population 1. The
more imbedded in the daily practice of health care.
focus of this article is the evaluation of the erects of
The Belgian-Dutch Clinical Pathway Network, in
clinical pathways. Two questions are raised.
which more than thirty Belgian and Dutch hospitals
1. Which indicators are available to the interdisci-
participate, is a good example of the interest in clini-
plinary team to evaluate a concrete clinical pathway
cal pathways 1-3. A clinical pathway is defined here as
adequately? Continuous evaluation and follow up are
essential to guarantee the good functioning of a clini-
cal pathway; one proposes the Clinical Pathway
P Vim Herck, RN, MSc, Student, K Vanhaecht, RN,
Compass (Figure 1)3. Effects are measured in five dis-
MSc, Research Fellou~ W Sermeus, RN, PhD, Projessor
tinct domains: clinical outcome, service, team, process
ill Patient Care Manaoement, Centrefor Health Services
and financial. Clinical outcome indicators, such as the
and Nursilli? Research, School of Public Hcalth, Catholic
degree of pain, infection, self-activation at discharge,
University Leuuen, Belgium,
self-care ability and re-admission rate focus on the
Correspondence to: KV impact of the clinical pathway on the clinical out-
E-mail: Kris.T/anhaecht@mcd.kuleuvcll.ac.be come. Service indicators, such as patient satisfaction,
sense of safety and anxiety are indicators with regard

J()UI~NAL OF INTEC;I'ATEIJ CAI'[ PATHWAYS (211114) 8. 95-{()5 © T1<" n"I'''! S"""I' ,,(Medicine I'res.< 2()().J

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

96 Journal oJ

to the perception of quality of care by the patient. 'clinical pathway', 'critical pathway', 'care map, care
Team indicators such as team effectiveness, job satis- pathway' and 'integrated care pathway'. These key-
faction and communication represent the quality of words resulted in a total of 1474 articles. More than
interdisciplinary collaboration. Process indicators such half of them related to 'pathways' in a biochemical or
as the results of deviation analysis and the conformity pharmacological sense. A total of 613 articles con-
rate between the course of care and the clinical path- cerned the concept 'clinical pathways' as described by
way give an indication of how care is organized. Sermeus & Vanhaecht'',
Finally, financial indicators, such as income, costs and The 613 available articles were then assessed by
length of stay, focus on costs, resource-utilization, effi- title and abstract. Articles containing any form of
ciency and benefit". evaluation, outcome or indicator concerning the use
In this study, the objective was to describe to what of clinical pathways were retained. This resulted in
extent all five domains' effects are covered in the lit- 111 relevant articles in which the abstract was
erature. detailed enough to analyse. For 97 other articles the
2. The second series of questions focuses on the abstract gave insufficient detail and the full article was
result of the effect evaluation. What's the global effect searched for further evaluation. Out of these, eight
of the implementation of clinical pathways on each of articles could not be reviewed because they were not
the' five effect domains? In a study reviewing the available, either in the library or electronically. In total
period 1988-2000 positive results were found:'. 200 articles were selected for the evaluation.
Clinical pathways advance information, patient edu-
cation and working in a systematic manner. They also Analysis
improve the quality of patient care 4. Research by de Relevant data were summarized in tables using the fol-
Luc confirms that the use of clinical pathways leads lowing characteristics: country of origin, clinical field
to positive results for clinical effectiveness, efficiency, of expertise, research design, sample size, clinical out-
streamlining of care, improved communication and come indicators, service indicators, team indicators,
patient centeredness". Some studies from the period process indicators and financial indicators. For each
1988-2000, however, show little or no difference domain a positive, negative or 'no difference' conclu-
after the implementation of a clinical pathway. sion was recorded. Excel® and Statistica® were used
Furthermore one has to consider methodological to obtain percentages and graphics.
restrictions (selection of research design, sample size,
choice of indicators and scales for measurernentj '. RESULTS
Describing the sample
METHODS
A total of 208 articles (34%) contained any form of
Search strategy evaluation concerning clinical pathways. The clinical
For identification and selection of relevant articles pathway was developed and assessed in the US in
Medline was searched for the period January 2000 to 55.5% of the 200 selected articles, in the UK in
December 2002. The search focused on the terms 11.5'/i" Australia in 11%, Japan in 4'/i,7-13 and Canada
in 3.5%14-:W. The other clinical pathway evaluations
came from Taiwan21<~'" Singapore 2('-2,), Spain 30-32,
Denmark33.34, Germany3S.:V" Switzeriand'V, Sweden}>I,
Finland}'), Ireland'l", Italy41 and New Zealand'".
A total of 48% of the assessed clinical pathways
were developed for surgery; 26% dealt with medical
issues such as asthma, pneumonia and stroke; 5% cov-
ered the field of rehabilitation 43-s2; 4% covered psy-
chiatry"3-(,o and 3% dealt with emergency
medicine 13,20J,1-(,7, Other clinical pathways were
developed for donor management I >1,(,>1, laborato-
ries o'),7o, radiologv''", palliative care 71,72, nursing edu-
cation/:', specific prevention of falling" or pressure
sores/". Remarkably, 9% of papers addressed paedi-
atrics whilst only 3,5% of the clinical pathways
focused on the elderly, Experimental design was used
Figure 1 Clinical pathway compass" in 9% of articles": 14-17,31,43,4>1,49,(,2,74,76->1 I; 45% used a

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

 Journal of 97

quasi-experimental design; 17.5% were observational

studies; 4.5% were systematic reviews; and 10%, gave a
subjective opinion about the effects of clinical path-
ways without any kind of scientific evaluation. The
remaining articles dealt with analysis of varia-
tions 72 ,H2- H5 or were of a qualitative nature S4 ,w,. The
design was unmentioned or unclear in 16.5%, of the
reviewed articles.
Aggregated data of sample size show a normal
distribution. The mean sample size was 100-200
subjects, varying from less than 50 to more than
1000. In 26% of the articles the sample size
remained unclear; 7%, of studies comprised multi-
centre research 17,74,7h.7H,H7-')(,; and 8'11', dealt with a
Figure 2 Evaluation per domain of the Clinical Pathway
sample of 1000 or more subjects 14,h3,h4,H7,HH,'!\ ,'!7-102. Compass in the literature, 2000-2002

Indicators used and to what extent

The extent to which each of the domains of the Team and service effects were discussed less often
Clinical Pathway Compass were assessed in literature (24% and 18.5% of papers, respectively). Tabk 1 pre-
is presented in Figure 2. Clinical outcome and sents the most frequently used indicatcrs per
financial effects were emphasized in 65.5% and 63% domain.
of papers, respectively. Process effects were also For clinical outcome a variety of indicators were
mentioned or investigated by half of the authors. recorded: number of re-admissions, complications,

Table 1 Most frequently used indicators in literature (2000-2002) per domain of the clinical pathway compass

Domain Indicators

Clinical indicators • number of re-admissions: 24%

• number of complications: 20.5%
• mortality: 13%
• number of admissions or length of stay on IC: 9%
• number of prevented admissions: 8.5%
• relapse without re-admission: 4%

Service indicators • influence on patient satisfaction: 18.5%

Process indicators • analysis of deviations: 14%

• number of clinical examinations (labs, radiology): 14%
• analysis of process flow, time schedules: 13.5%
• completeness and quality of documentation: 10%
• influence on goal setting, prioritizing and planning: 7.5%
• influence on process transparency, overview and clearness: 7%

Team indicators • influence on team communication: 12%

• influence on team satisfaction: 8.5%
• influence on education, knowledge and competence: 6.5%
• influence on autonomy of physician and nursing personnel: 5.5%
• influence on understanding, recognition and appreciation of roles, self-confidence: 3%

Financial indicators • influence on length of stay: 54.5%

• influence on costs: 38%
• influence on consumption of material resources: 9.5%
• influence on amount of labour: 8%

IC, Intensive care

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

98 Journal oJ

mortality, number of admissions, length of stay in Table 2 Global effect of the implementation of clinical pathways,
intensive care, number of prevented admissions, num- described in the literature (2000-2002) per domain of the clinical
pathway compass
ber of relapses without admission, influence on edu-
.
cation, k nowid e ge an d d eClSlon.. ma kimg 117
.' .'1') .41 .
SO,56.60,71 ,K3,<J3,lll3-111, time until extubation 112-11 <J, Positive No Negative
time until normal food intake 33,KO,l17,120-123, quality effect (%) effect (%) effect (%)
of life14,lS,17,43,4<J,%,124, number of infections l1K,124-12K
Clinical outcome 65,6 32 2.4
and level of pain 45,72,')3,117,122,l23. Of the clinical out-
Service 62,2 29,7 8,1
come indicators used, 17% were very specific and Process 86 7 7
linked to pathology, mainly in the cases of stroke, Team 83.3 6.3 10.4
oncology and urology, Service effects were almost Financial 82.5 13.5 4
always measured as 'patient satisfaction', Only one
article mentioned family satisfactiorr'" or parent satis-
faction'':'.
Process indicators can vary: analysis of deviations, effects, 4'1<'1 for financial effects and 2.4% for clinical
number of medical examinations, analysis of process outcome.
flow, etc. The most frequently used indicators were:
number of procedures22,6'J,12'), number of observa- DISCUSSION
tions or registrations of certain medical parame-
ters K5,130, number of prescriptions105,107,131, degree of Describing the sample
support for clinical decision making2'J,37,75, degree of The term 'clinical pathway' sometimes leads to con-
support for patient triage 42, influence on administra- fusion, Similarity in terminology between different
tion K6,132-134, influence on process evolution, renewal schools doesn't help to reach an unambiguous under-
and adaptation 2<J,c'O,KS,132,133,13S-13<J, degree of promo- standing and also complicates the search for relevant
tion/opposition of the continuun/ 5,134 and degree of literature, Moreover it creates the wrong perception
evidence-based practice SS,56,<J3,l 06,133,13S,140,141 , of the extent to which clinical pathways are discussed
Team indicators focused on communication, team in literature,
satisfaction, education, autonomy and role recognition, In only one third of the articles were the effects of
influence on attitude towards teamwork 'Y, course of the implementation of a clinical pathway evaluated,
working in a team 11,%,142-144, interdisciplinary collabo- This could be called a poor result.
ration12,20,2'J,K4,<J3,145,14(), morals and motivation1o(),13<J, The review confirmed the worldwide use of clinical
team building and cohesion 2'J,lOK,142,146, and team pathways in health care. In particular, the US sets great
skills104, store by an optimal process flow and evidence-based
Financial effects were given as: length of stay, cost, health care, Other countries are gaining on them,
consumption of material resources, amount of labour, It is no surprise that surgery and medicine in partic-
influence on effici ency12,2'),147,14K, amount of time ular are at the centre of current developments, Some
spent during a certain activi ty34,73 and sum of money authors argue that the prospects of clinical pathways are
charged to the patient 25, limited by the degree of predictability of care 3,4, 132, 133,
Nevertheless some successful initiatives can be found in
Global effect of the implementation of clinical more unpredictable fields such as rehabilitation and
pathways per domain of the Clinical Pathway psychi atry44-46.4K,50,52,55-5K,6o,7s, 14'), lS0,
Compass The methodology of studies assessing the use of clin-
The majority of literature between 2000 and 2002 ical pathways is often criticisedS1,124, 132, 133,14K,151,152.
concluded that there were positive effects to imple- Given the research designs and the sample sizes of the
menting clinical pathways (Table 2), According to relevant articles, one can conclude that this criticism is
more than 80% of the authors, three domains were justified, The lack of information about fundamental
positively affected by the implementation of a clinical methodological choices and steps is particularly striking,
pathway. For the remainder of domains 60% reached On the other hand there are large multicentre studies
the same conclusion, With regard to clinical outcome, available with an appropriate design that confirm the
service and financial effect no difference was general result,
observed by 32%, 29,7% and 13,5% of the authors, Many authors were interested in clinical outcome
respectively, A minority found negative results in any and financial effects, For both domains good indica-
domain, Negative results occurred in 10.4% of papers tors exist, Almost all indicators presenting clinical out-
for team effects, 8.1% for service, 7% for process come were specific, concrete and measurable. The link

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

 Journal if 99

with clinical outcome was usually clear and logical. patient satisfaction was evaluated without reasonmg.
These indicators have to be evaluated in accordance An alternative measure was the number of patient
with pathology. Standards for comparison were very complaints.
different. A number of clinical outcome indicators are In spite of possible methodological objections
widely used in the fields of surgery and medicine. It is about studies assessing the use of clinical pathways,
therefore surprising that in most articles only one or there was strong evidence that clinical pathways
two clinical outcome indicators were evaluated. result in positive effects. The results of a previous
Financial indicators were limited. Most authors review'> were confirmed to a great extent. 'No
showed interest in length of stay and costs. It effect' and negative effects appeared in the literature
remained unclear how costs were calculated. Many much less than positive effects. The results were
articles gave a figure for cost reduction. The reason especially encouraging for process, team and finan-
why was not fully explained. The point of view from cial effects, But also with regard to clinical outcome
which the financial aspect was assessed, was not clari- and service, clinical pathways seem to lead to suc-
fied: benefit for the patient, the involved institution or cess. A more concrete content of the benefits can
the government? Items such as consumption of mate- be extracted from the indicators used. The fact that
rial resources, amount of labour and time spent can be a relatively large 'no effect' proportion was found in
useful as alternative indicators. The amount of labour clinical outcome effects can be partially explained
could be further broken down into the number of per- by the difference in focus: a number of clinical
sonnel, number of labour hours, labour costs, etc. The pathways were particularly intended to improve
latter were not mentioned in the 2000-2002 literature financial aspects. For the latter a 'no effect' result
on clinical pathways. Sometimes the cost of resources concerning clinical outcome was considered suffi-
can mount Up2SJ,5H,H 1,'n, I I.>,14H,15'>. It is unclear to what cient. Other clinical pathways focused explicitly on
extent this issue is addressed. Some authors confirm clinical outcome.
this shortcoming U2,14H,151. The eye catching negative results were the no dif-
Process effects are investigated or discussed in half ference percentage in service effects (29.7%) and the
of the articles. Attention is clearly growing, but there negative effects regarding the team (10.4%) and ser-
is much less conformity with regard to concrete vice (8.1 'YtJ) domains. Perhaps clinical pathways were
translations in generally applicable items. The number less often developed to improve team or service, or
of terms and techniques varies widely. Analysis of these domains could also be less easily influenced.
variances, process flow and measuring the number of Notice that both these domains were evaluated least
medical examinations, procedures and prescriptions often. Studies leading to negative results should be
seem most objectively quantifiable. analysed thoroughly to determine the causes. Each
Team and service evaluation were less discussed negative effect on clinical outcome is one too many,
in the literature. Team effects were measured very This also counts for the other domains.
differently. There were, however, few measurable Some authors mentioned the influence of the
items. Possibilities, such as, personnel complaints, Hawthorne effect when a clinical pathway was being
absence ratios through illness and staff turnover implemented. Surely in the beginning phase this will
were not utilized. OIl the other hand the focus on play a part. The majority of the reviewed studies
aspects, such as, influence on education, knowledge however, examined the effects through the y'~ars. A
and competence, and the influence on autonomy second critique on the positive influence of clinical
were considered very positive. The influence on pathways is the assumption that the positive effects
autonomy of nursing staff was in general mostly would be attained anyhow, even without the aid of a
favourable 57,5H, 11 SJ, 144,145, 154. The autonomy of clinical pathway. Financially some studies confirmed
physicians was somewhat reduced by the implemen- this HH, 157, The results of multicentre studies, however,
tation of a clinical pathway, but it did not affect clearly showed the beneficial effects of clinical path-
diagnostic and therapeutic freedom 2SJ,u6,14H, Team ways on their own. Finally one can argue that
effectiveness was assessed very vaguely as, for improvement is mainly a consequence of the imple-
instance, 'team skills'. New instruments were in mentation of new techniques, technology or medica-
development, such as, the questionnaire on team tion. Indeed, many clinical pathways made use of
effectiveness 155. Gittell proposed the degree of com- evidence-based medicine and guidelines in their
munication and relational coordination as team development 1SJ,27,6(,,75,76,H1,'i4, lOS, 10'), 116,140,152,15'>. The
indicators 15(). application of evidence-based health care is consid-
Of all the domains of the Clinical Pathway ered an essential component of a clinical pathway. If
Compass, service was the least discussed. In addition, positive results are achieved in this way, one has to

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

100 Journal of

bear in mind that this could mainly happen through the results regarding the use of indicators, neither for
the clinical pathway. the global evaluation of the use of clinical pathways.
It was not an objective of this review to investigate After all, sufficient information concerning content
the links between country of origin, field of exper- and conclusions of the described assessment, outcome
tise, research design and use of indicators. Therefore, or indicator was the most important demand. If this
their relations and results were not examined statisti- was not provided in the abstract, the full article was
cally. Nevertheless in the course of the review a num- analysed. Analysis by abstract could however have
ber of general trends were found that could not be affected the methodological assessment of the articles
overlooked. in a negative sense. This could partially explain the
One cannot deny the impression that the US and fairly large degree of uncertainty with regard to
the Asian world were mostly interested in financial research design and sample size. Yet finding the same
benefits between 2000 and 2002. Their studies also proportions of indistinctness in the fully analysed arti-
put clinical outcome in the picture, but mainly as a cles contradicts this objection.
'no difference' condition. The goal was to cut costs A second critique concerns publication bias.
rather than to seek clinical improvement. This is Clinical pathways with no, few or even negative
surely understandable in the current context of sav- results hardly ever get published.'. This is surely some-
ings and shortages in health care. The aim seems to be thing to take into account during the assessment of
to boost efficiency and keep a level of quality. Many the results of this review.
authors from the UK, Australia and Canada strived
directly for a better clinical outcome. Financial effects
CONCLUSIONS
played an additional part. The same evolution was
found for process and team effects. The UK in partic- The evaluation of the use of clinical pathways shows
ular had a growing interest in these domains. With room for improvement. Clinical outcome, process and
regard to service effects no difference in interest was financial effects are assessed on a regular basis. There is
noticed between different countries. however still insufficient attention paid to team and
The selection of clinical outcome indicators was service effects.
linked to the clinical field of expertise for which the Concerning the use of indicators, one finds in
clinical pathways were developed. Indicators for clinical pathway literature a broad range of useful
surgery, medicine or emergency medicine seemed to clinical outcome and process indicators. Good finan-
be more straightforward than the indicators for reha- cial and team indicators are also available, yet these
bilitation or psychiatry, i.e. looking for effect on edu- are used vaguely and inconsistently. A more struc-
cation, knowledge and decision making, quality of tured approach is needed. The development of service
life, number of patient goals reached and influence on indicators in the assessment of clinical pathways is still
self care. A second difference concerns the financial in its infancy.
indicators. In fields such as rehabilitation and psychia- Otherwise, next to clinical pathways in the fields
try, financial effects were not the focus as was the case of surgery and medicine small initiatives are gradually
in surgery or medicine. The other four domains of starting to arise in more unpredictable fields of exper-
the Clinical Pathway Compass were more at the cen- tise. These unexplored new grounds raise many ques-
tre, probably not just for the sake of idealism, but also tions, including when it comes to evaluation. Already
because cutting costs is much more difficult to realize it is clear for instance, that the common clinical out-
in these fields. come indicators will need adjustment to fit in with
Clinical outcome and financial effects were these new demands.
assessed in good quantitative research largely of a Clinical pathways result globally in positive effects.
quasi-experimental nature. Process and team indica- 'No difference' in one domain often means positive
tors have not yet found their place in scientific results in another. Negative results however, were also
research concerning clinical pathways. It is somewhat present in the literature. The latter deserve most
limited to opinions, which has less evidential value. attention as a means for adaptation and improvement.
The majority of process effects were examined by In a macro-evaluation one has to take into account
analysis of deviations. Service effects were assessed in the issue of publication bias and the fact that the
all possible forms of research. effects of clinical pathways are not mentioned or
examined by two thirds of the authors.
Limitations of the review Finally, one cannot emphasize enough the impor-
Of the 200 selected articles, 111 were analysed on tance of rigorous scientific research. This also includes
abstract alone. This had no or few consequences for a detailed description of methodology. In particular in

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

 101
Journal if

process, team and service assessment concerning the 16 Palmer CS, Zhan C, Elixhauser A, Halpern MT, Rance L,
use of clinical pathways, there is still a great need for Feagan l3G, ct al. Economic assessment of the community-
acquired pneumonia intervention employing levofloxacin.
research with high evidential value.
Clillical Tltempy 2000; 22: 250-64
17 Marr ic Tj, Lau CY, Wheeler SL, Wong Cj, Vandervoort MK,
Feagan BG. A controlled trial of a critical pathway for
Rejerences treatment of community-acquired pneumonia. CAPITAL
Study Investigators. Community-Acquired Pneumonia
Sermeus W,Vanhaecht K,Vleugels A. The Belgian-Dutch Intervention Trial Assessing Levofloxacin.joul'l1al 4 the
Clinical Pathway Net"lNork.jolimal oOIl/i:~raled Care Pathu.ays American Medical Association 2000; 283: 749-55
2001;5: 10-14 1R Gillham-Eisen LA, Holmgren E. Clinical pathways. The
2 Sermeus W, Giebens K, Vanhaecht K, De Witte K, Haspeslagh Ottawa Hospital Organ and Tissue Donation Program.
M,Vleugels A. Her Vla.uns-Ncdcrlands Netwerk Kliuische Canadian Nurse 2002; 9R: lR-24
Paden. Acta Hospitalia 2002; 3: 29-39 19 Levesque j, Lacourciere Y, Onrot jM, Wilson SR, Szaky E,
3 Vanhaecht K, Serrncus W,Vleugels A, Peeters G. Ontwikkeling Thibodeau M, ct al. Economic impact of an ultrasonographic
en gebruik van klinische paden ('clinical pathways') in de contrast agent on the diagnosis and initial management of
gezondheidszorg. Ti;dscltr!ft voor Gcnccsleundc 2002; 58: patients with suspected renal artery stenosis. Canadian
1542-51 Associatioll of Radio"~~y [ourua! 2002; 53: 22R-36
4 Skalkidis Y, Stavropoulou A. Critical paths: monitoring and 20 Martin Ll' Implementing a critical pathway for oral
evaluating the quality of patient care. European Nurse 1996; 1: rehydration of mild to moderate dehydration of children.
159-66 jOllrrtal of EII/(~~CIlCY Nursinc 2001; 27: 5')7-601
5 De Luc K. Are different models of care pathways being 21 Chang PL, Lee SH, Hsieh ML, Huang ST,Tsui KH, Lai RH.
developed' lntcnuuionaljvurual 4 Health Care Quality Improvement of practice performance in urological surgery
Assurallce 2000; 13: 80~6 via clinical pathway implementation. vVcl/'ld jOIl rna I of Urology
6 Sermeus W,Vanhaecht K. Wat zijn klinischc paden' Acta 2002;20:213-8
Hospitalia 2002; 3: 5-11 22 Lin YK, Su jY, Lin GT, Tien YC, Chien SS, Lin Cj, ct al.
7 Uchiyama K,Takifuji K,Tani M, Onishi H,Yalllaue H. Impact of a clinical pathway for total knee arthroplasty.
Effectiveness of the clinical pathway to decrease length of stay Kaohsiuno journol olMcdical Science 2002; 18: 134-40
and cost for laparoscopic surgery. SIII:~ical I;lIdoscopy 2002; 1(,: 23 Lee SC, Tseng HY, Wang KY, Lee LC. Effect of a clinical
1594-7 pathway on selected clinical outcomes of pulmonary
8 Aizawa T, Kin T, Kitsukawa S, Mamiya Y, Akiyama A, Ohno Y, lobectomy. ZllOlIglzlla Yi X/Ie Za Ziti 2002; 65: 7-12
ct at. Impact of an clinical pathway in cases of transurethral 24 Chang PL,WangTM, Huang ST, Hsied ML, ChuangYC,
resection of the prostate. NIJ!POIl tlinvolsilea Cakkai Zasslii Chang CH.Improvement of health outcomes after continued
2002; 93: 463-R [japanese] implementation of a clinical pathway for radical nephrectomy.
9 Matsumoto A, Kanda K, Shigematsu H. Development and f;f;('rld jOIl rtta I ,~( Urology 2000; 18: 417~21
implementation of a critical pathway for abdominal aortic 25 Chang PL, Li YC, Lee SH. The differences in health outcomes
aneurysms in japan.jo/Jrllal 4 Vaswlar Nllrsillg 2002; 20: 142-1 between Web-based and paper-based implementation of a
10 Kondo T,Tomita K.Thyroid tumour clinical path. Nippon clinical pathway for radical nephrectomy. BritishJOllrrtol of
jibiillkoka Cakkai Kaiho 2001; 104: 1017~24 [japanese] Urology lntcmational 2002; 90: 522-R
11 Muto M, Konishi T. Critical paths and economical efficiency 26 Santoso U, Iau PT, Lim j, Koh CS, Pang YT. The mastectomy
on cancer therapy. Catl Til K(/,~aku Ryolto 2000; 27: 1380-9 clinical pathway: what has it achieved' Annual Amdclllic
[japanese] Medicine Sillgapore 2002; 31: 440-5
12 Koyama K, Ito M, Kotanagi H. Improvement of the efficiency 27 Abisheganaden j, Chee Cl3, Goh SK,Yeo LS, Prabhakaran L,
of the treatment of gastric cancer by the standardization of Earnest A, (I al. Impact of an asthma carepath on the
the treatment plan. Call To Kagabl Rvolio 2000; 27: 1375-9 management of acute asthma exacerbations. Annual Acade/Ilic
[japanese] Medicine Sillgapore 2001; 30(4 Suppl): 22-6
13 Nakamura I, Hori S, Suzuki Mi Asakura Y,Yoshikawa T, 28 Cheah J. Clinical pathways - an evaluation of its impact on
Ogawa S, ct a]. Critical pathway improves ar r ival-in-catli-lab the quality of care in an acute care general hospital ill
interval for patients with acute myocardial infarction in the Singapore. Si/l,~apor(' Medical jo/trllal 2000; 41: 335-46
emergency department.japallcsc Circulation jo II I'll a! 200 I; 65: 2') Venketasubramanian N. Stroke pathways. Annual Acadcli/ic
849-52 Medicine Sincapovc 2001; 30: 27-35
14 Feagan BG. A controlled trial of a critical pathway for treating 30 Sanchez Merino jM, Parra Muntaner L, Gomez Cisneros SC,
community-acquired pneumonia: the CAPITAL study. Monsalve Rodriguez M,jimenez Rodriguez M, Garcia
Community-Acquired Pneumonia Intervention Trial Alonso J. Implementation of a clinical pathway for
Assessing Lcvofloxacin. Plumuacothcrapv 2001; 21 (7 Pt 2): transurethral resection in benign prostatic hyperplasia. Auuivcs
89S-94S Esp Urology 2002; 55: 131~44
15 Farquhar D. Use of a critical pathway for the management of 31 Nunez Mora C, Chamorro Ramos L, Rendon Sanchez D,
community-acquired pneumonia: the CAPITAL Study. Rios Gonzalez E, Pastor Arquero T, Aguilera Bazan A, ct al.
Canadian Medica! Associatioll jou I'll aI 2000; 163: 755 Clinical pathway forTUR of bladder neoplasms. Analysis of

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

102 Journal of
the first 2 years of its implementation. Archives Esp Urology 4'1', Sulch D, Evans A, Melbourn A, Kalra L. Does an integrated
2001; 54: 777-'1',6 [Spanish] care pathway improve processes of care in stroke
32 Isla-Guerrero A, Chamorro-Ramos L,Alvarez-Ruiz F, rehabilitation; A randomized controlled trial. Age Ageill.~
Aranda-Armengod 13, Sarmiento-Martinez MA, Perez- 2002; 31: 175-9
Alvarez M, ct al. Design, implementation, and results of the 49 Sulch 0, Perez I, Melbourn A, Kalra L. Randomized
clinical pathway for herniated lumbar disk. Ncurociruyia 2001; controlled trial of integrated (managed) care pathway for
12: 409-18 [Spanish] stroke rehabilitation. Stroke 2000; 31: 1929-34
33 Basse L, Hjort Jakobsen D, 13illesbolle p,Werner M, Kehler H. 50 Mamolen NL, Brenner PS. The impact of a burn wound
A clinical pathway to accelerate recovery after colonic education program and implementation of a clinical pathway
resection. Annals of SlIIgcry 2000; 232: 51-7 on patient outcomes.jolll'llal (!f BIII'l1 Care Rehabilitation 2000;
34 Rasmussen S, Kristensen 1313, Foldager S, Myhrmann S, Kehlet 21: 440-5
H, Hofrefiakturgruppc H. Accelerated recovery program after 51 Sulch D, Kalra L. Integrated care pathways in stroke
hip fracture surgery. Ugeskr Lacocr 2002; 165: 29-33 [Danish] management. Age and Ageillg 2000; 29: 349-52
35 Teichgraber UK, Neumann F,Boeck J, Ricke J, Felix R. 52 Gorski LA.A clinical pathway for deep vein thrombosis. Home
Process management in computed tomography: using critical llcaltlicarc Nurse 2000; 18: 451-61
pathway method to design and improve work flow in 53 Magyary D, Brandt P. A decision tree and clinical paths for the
computed tomography. European [ourna! c!f Radiology 2000; 10: assessment and management of children with ADHD. Issues
S370-6 MCIllal Health Nursino 2002; 23: 553-66
36 Torscllo G, Klenk E, Kasprzak B. First experiences with 54 Jones A. Hospital care pathways for patients with
clinical pathways in carotid surgery. Zcntmlb! Chit 2002; 127: schizophrenia.jozmwl of Cliuica! Nllrsillg 200 I; 10: 58-69
656-9 [German] 55 Horner GH. Mapping the road to quality collaborative
37 Chevalley T, Hoffineyer P,Bonjour JP, Rizzoli R. An patient care in a behavioral health community treatment
osteoporosis clinical pathway for the medical management of center. Avoiding the detours of managed care. Psvcbiatric
patients with low-trauma fracture. Osteoporosis Intcmational Clinics of Nortli America 2000; 23: 363-82
2002; 13:450~5 56 Browning R, Hollingbery T. Mental health. For good
38 Walldal E, Anund I, Furaker C. Quality of care and measure. Health Service jOlll'llal 2000; 110: 34-5
development of a critical pathway.jolll'llal (!f Nursino 57 Walmsley P. Who's next in the queue; Nursillg Manaoenicut
Manaocnicut 2002; 10: 115-22 2000;6: 18-21
39 Renholm M, Leino-Kilpi H, Suominen T. Critical pathways. 58 Brett W, Schofield J. Integrated care pathways for patients
A systematic ccvicwjourna! of Nursillg Administration 2002; 32: with complex needs. Nursinc Standard 2002; 16: 36-40
196-202 59 Beavis 0, Simpson S, Graham I. A literature review of
40 Marley AM.A care pathway for COPD. Professional Nurse dementia care mapping: methodological considerations and
2000; 16:821-3 efficacy.joul'llal of Psychiatric Mental Health Nursini; 2002; 9:
41 Piccoli GB, Mezza E, Iadarola AM, Bechis F, Anania P,Vischi 725-3(,
M, ct al. Education as a clinical tool for self-dialysis. Advanced 60 Baker JA, O'Higgins H, Parkinson j.Traccy N.The
Peritoneal Dialysis 2000; 16: 186-90 construction and implementation of a psychosocial
42 Edmond JJ, French JK, Henny H, Belz LM, West T, Stewart interventions care pathway within a low secure environment:
R, et al, Prospective evaluation of a chest pain pathway at a pilot study.joul'Ilal of Psychiatric Mental Health Nursiuo 2002;
Green Lane Hospital. New Zealand Medical [ouma! 2002; 115: 9:737-9
U103. 61 Chin R, Browne GJ, Lam LT, McCaskill ME, Pasher 13, Hort
43 Sulch D, Melbourn A, Perez I, Kalra L. Integrated care J. Effectiveness of a group clinical pathway in the
pathways and quality oflife on a stroke rehabilitation unit. management of children with croup presenting to an
Strolec 2002; 33: 1600-4 emergency department.joul'Ilal of Paediatric Child Health 2002;
44 Hassan N, Turner-Stokes L, Pierce K, Clegg F. A completed 38:382-7
audit cycle and integrated care pathway for the management 62 Kim MH, Morady F, Conlon 13, Kronick S, Lowell M,
of depression following brain injury in a rehabilitation setting. Bruckman 0, el al. A prospective, randomized, controlled trial
Clinical Rcltabilitation 2002; 16: 534-40 of an emergency department-based atrial fibriliation
45 Jackson 0, Turner-Stokes L, Khatoon A, Stern H, Knight L, treatment strategy with low-molecular-weight heparin.
O'Connell A. Development of an integrated care pathway for Annual Emcrocnc» Medicine 2002; 40: 187-92
the management of hemiplegic shoulder pain. Disability 63 Browne GJ, Giles H, McCaskill ME, Pasher BJ, Lam LT.The
Rchabititation 2002; 24: 390-8 benefits of using clinical pathways for managing acute
46 Playford ED, Sachs R, Thompson AJ. Integrated care paediatric illness in an emergency department.jollmal (!f
pathways: outcome from inpatient rehabilitation following Qllalily Clinica! Practice 2001; 21: 50-5
nontraumatic spinal cord lesion. Clinical Rcliabilitation 2002; 64 Ng SM, Krishnaswarny P, Morissey R, Clopton I~ Fitzgerald
16:269-75 R, Maisel AS. Ninety-minute accelerated critical pathway for
47 Turner-Stokes L, Hassan N, Pierce K, Clegg F. Managing chest pain evaluation. Americall[ourna! c!f Cardiology 2001; 88:
depression in brain injury rehabilitation: the use of an 611-7
integrated care pathway and preliminary report of response to 65 Vinson DR, Berman DA. Outpatient treatment of deep
sertraline. Clinical Rchabititution 2002; 16: 261-8 venous thrombosis: a clinical care pathway managed by the

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

 Journal of 103

emergency department. Annual Eincrocnc» Medicine 2001; 37: 82 Wilson S, Bin J, Sesperez J, Seger M, Sugrue M. Clinical
251-8 pathways - can they be used in trauma care. An analysis of
66 Masters G, Hall SE, Phillips M, Boldy D. Outcomes their ability to fit the patient. lnjurv 2001; 32: 525-32
measurement for asthma following acute presentation to an 83 Cabello CC Use of variance outcomes to improve the
emergency department. Australian Health Review 2001; 24: management of the adult kidney transplant patient. Outcomes
53-60 Manaocntcnt Nursino Practice 2001; 5: 153-8
67 Fleischmann KE, Goldman L,Johnson PA, Krasuski RA, 84 Pearson JB, Macintosh OJ. Caring about carepaths. Australian
Bohan JS, Hartley LH, et al. Critical pathways for patients Health Review 2001; 24: 1-8
with acute chest pain at low risk.jollrnal of'lhrombosis and 85 Selwood K. Integrated care pathways: an audit tool in
Thrombolysis 2002; 13: 89-96 paediatric oncology. British [ourna! '!f Nllrsillg 2000; 9: 34-8
68 Rosendale JD, Chabalewski FL, McBride MA, Garrity ER, 86 Hoffart N, Cobb AK. Assessing clinical pathways use in a
Rosengard BR, Delmonico FL, ct al. Increased transplanted community hospital: it depends on what 'use' means.joint
organs from the usc of a standardized donor management Commission [ouma! 011 Qllality ltnprovcntcut 2002; 28: 167-79
protocol. AllIerican [ourna! of 'lransplantation 2002; 2: 7(,1-8 87 Meehan TP, Weingarten SR, Holmboe ES, Mathur 0, Wang Y,
69 Persoon TJ, Zaleski MS, Cohen MB. Improving Pap test Petrillo MK, ct al.A statewide initiative to improve the care of
turnaround time using external benchmark data and hospitalized pneumonia patients: The Connecticut
engineering process improvement tools. Anlerican [ourna! of Pneumonia Pathway Project. AllIeriwII [ourna! o(ivIedicine
Clinical Pathology 2002; 118: 527-33 2001; 111:203-10
70 Robinson TN, Biffi WL, Moore EE, Heimbach JK, Calkins 88 Pearson SO, Kleefield SF,Soukop jn, Cook EF, Lee TH.
CM, Burch J. Routine preoperative laboratory analyses are Critical pathways intervention to reduce length of hospital
unnecessary before elective laparoscopic cholecystectomy. stay. AllIcricall [ournal of Medicine 2001; 110: 175-80
Slllgical Endoscop» 2003; 17: 438-41 89 March LM, Cameron ID, Cumming RG, Chamberlain AC,
71 Fowell A, Finlay l.A good death. Care pathway in Wales aims Schwarz JM, Bruabic AJ, ct al. Mortality and morbidity after
to improve care of dying patients. Blv1] 2000; 320: 1206 hip fracture: can evidence based clinical pathways make a
72 Fowell A, Finlay I,Johnstone R, Minto L. An integrated care difference' [ourual '1"RhClllllatology 2000; 27: 2227-31
pathway for the last two days of life:Wales-wide 90 Tichawa U. Creating a continuum of care for elderly
benchmarking in pallialtve care. lnternationai journal of individuals.jorrnm! oj Gerontology Nursino 2002; 28: 46-52
Palliative Nursing 2002; 8: 566-73 91 Metersky ML, Fine JM, Tu GS, Mathur 0, Weingarten S,
73 Castellino AR, Schuster PM. Evaluation of outcomes in Petrillo MK, et al. Lack of effect of a pneumonia clinical
nursing students using clinical concept map care plans. Nurse pathway on hospital-based pneumococcal vaccination rates.
Education 2002; 27: 149-50 Anicrican journat ,~f Medicine 2001; 110: 141-3
74 Lightbody E,Watkins C, Leathley M, Sharma A, Lye M. 92 Todaro T, Schott-Baer D. Plan faster, healthier recovery after
Evaluation of a nurse-led falls prevention programme versus orthopedic surgery. Nursing Manager 2000; 31: 24-6
usual care: a randomized controlled trial. A,~e and Agein,~ 2002; 93 Cringles MC Developing an integrated care pathway to
31:203-10 manage cancer pain across primary, secondary and tertiary
75 Richardson J, Prentice 0, Rivers S. Developing an care. International [ourual ofPalliative Nllrsing 2002; 8: 247-55
interdisciplinary evidence-based skin care pathway for long- 94 Afable R.Voluntary CHF pathways cut costs, boost outcomes.
term care. Advanced Skill VV('lmd Care 2001; 14: 197-203 ClinicalResource Malwgel1lent 2001; 2: 33-6
76 Steinberg RB, Liu SS,Wu CL, Mackey DC, Grass JA, Ahlen 95 Ham J. Critical pathways for smaller hospitals in rural areas.
K, et al. Comparison of ropivacaine-fentalyl patient- Australian Health Review 200 I; 24: 100-4
controlled epidural analgesia with morphine intravenous 96 Dupler AM, Crogan NL, Short R. Pathways to quality
patient-controlled analgesia for perioperative analgesia and improvement for boarding homes: a Washington State model.
recovery after open colon surgery.jollrnal of Clinical journal ofNursino Care Qllality 2001; 15: 1-16
Allesthesiology 2002; 14: 571-7 97 Dunn TS, Stamm CA, Delorit M, Goldberg G. Clinical
77 Johnson KB, Blaisdell Cj, Walker A, Eggleston P Effectiveness pathway for evaluating women with abnormal uterine
of a clinical pathway for inpatient asthma management. bleeding.Jollmal orReproductive Medicine 2001; 4(,: 831-4
Pediatrics 2000; 106: 1006-12 98 Wazeka A,Valacer OJ, Cooper M, Caplan D\XI, DiMaio M.
78 Choong PF, Langford AK, Dowsey MM, Santamaria NM. Impact of a pediatric asthma clinical pathway on hospital cost
Clinical pathway for fractured neck of femur: a prospective, and length of stay. Pediatric PIIllllonology 2001; 32: 211-6
controlled study. Medical jOllrnal ofAustralia 2000; 172: 423-6 99 Podila PV,Ben-Menachcm T, Batra SK, Oruganti N, Posa P,
79 Board N, Brennan N, Caplan G. Use of pathology services in Fogel R. Managing patients with acute, nonvariceal
re-engineered clinical pathways.journal of Quality Clinical gastrointestinal hemrrhage: development and effectiveness of a
Practice 2000; 20: 24-9 clinical care pathway. Aincricau journal of Gastrocutcroloov 2001;
80 Buckley Cj, Patterson DE, Manning LG, Lee SD. Quality 96:208-19
vascular surgical care: the importance of innovation and 100 Brandsma C, Calhoun BC,Vannatta JE. Uncomplicated
change in an era of dwindling reimbursement. Southern pregnancy: clinical pathway genesis based on the nursing
Medical jOllmal 2001; 94: 411-6 process. Military Medicine 2000; 165: 839-43
81 Glauber JH, Farber HJ, Homer CJ. Asthma clinical pathways: 101 Philip AG, Mills PC Use of C-reactive protein in
toward what end? Pediatrics 2001; 107: 590-2 minimizing antibiotic exposure: experience with infants

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

104 Journal of

initially admitted to a well-baby nursery. Pediatric, 2000; 106: 2002;22:31-9

E4 120 Michalsky Mp, Pratt D, Caniono DA, Teich S. Streamlining
102 Maisel AS. Critical path network. New protocol can rule out the care of patients with hypertrophic pyloric stenosis:
Mis in 90 minutes. Hospital Case Mmw,~Clllellt 2002; 10: 55-7 application of a clinical pathway.jollrJlal of Pcdiatrical SlIIgery
103 Micik S, Borbasi S. Effect of support programme to reduce 2002;37: 1072-5
stress in spouses whose partners 'fall off' clinical pathways 121 Melbert RB, Kimmins MH, Isler JT, Billingham Rp, Lawton
post cardiac surgery. Australian Critiwl Care 2002; 15: 33-40 D, Salvadalena G, et al. Use of a critical pathway for colon
104 Moody G, Choong YY, Greenwood J. An action research resections.JollYllal oj Castrointcstiual Slllgery 2002; 6: 745-52
approach to the development of a clinical pathway for 122 Moore S. Laparoscopic nephrectomy pathway sees great
women requiring Caesarean sections. COlltelllporary Nurse outcomes. Hospital Case Manaocmcnt 2001; 9: 71,74
2001; 11: 195-205 123 Broder MS, Bovone S. Improving treatment outcomes with
105 Kelly CS, Andersen CL, Pestian Jp, Wenger AD, Finch AB, a clinical pathway for hysterectomy and myomectomy.
Strope GL, ct al. Improved outcomes for hospitalized [ourua! ofReproductive Medicine 2002; 47: 999-1003
asthmatic children using a clinical pathway. Annals (~fAIlCIgy 124 Kwan J, Sandercock P. In-hospital care pathways for stroke
Astlinia 1111 II1111 IOlogy 2000; 84: 509-16 (Cochrane systematic review). In: The Cochrane Library. Issue
106 Rogers SN, Naylor R, Potter L, Magennis P. Three years' 2. Oxford: Update Software, 2002
experience of collaborative care pathways on a maxillofacial 125 Kelly RE, Wenger A, Horton C Jr, Nuss D, Croitoru DP,
ward. British[ournal of Oral Maxillofacial Su\~ery 2000; 38: Pestian JI' The effects of a pediatric unilateral inguinal hernia
132-7 clinical pathway on quality and cost.jolll'lwi of Pediatrical
107 Eagle K, Montoye C. GAP program improves patients' Su\~ery 2000; 35: 1045-8
quality of care. Hospital Case Mmwgelllew 2002; 10: 85-6, 93 126 Gendron KM, Lai SY,Weinstein GS, Chalian AA, Husbands
108 Hahn J, Bishop G, Fennell L. Integrating service excellence JM,WolfpF, ct al. Clinical care pathway for head and neck
in a CHF clinical pathway pilot project.]cmYllal of Hcaltlicarc cancer: a valuable tool for decreasing resource utilization.
Qllality 2002; 24: 35-9, 44 Archives ~f OtolarYllgology Head Neck SUlgcry 2002; 128:
109 Scroggins NM, Houston S, Clark M, Cushman L. Challenge 258-62.
of managing intervcntional cardiology patients over a 127 Hanchett M, Enright C. Revising outcome measures for an
decade. Outcomes Managcnicn! Nursillg Practice 2001; 5: 173-8 established pathway. Hospital Case Manaocincnt 2000; 8:
110 Johns K, Denomme V Bowel resection pathway saves $2,500 183-6,178
per case, cuts LOS. Hospital Case Management 2000; 8: 103-6 128 Hypnar LA, Anderson L.Attaining superior outcomes with
111 Adams J. Clinical care pathways: decreasing resource joint replacement patients.jollmal of NursiuoAdministration
utilization in head and neck surgical patients. ORL Head and 2001;31:544-9
Neck Nursiuo 2000; 18: 23 129 Wee AS, Cooper WB, Chatham RK, Cobb AB, Murphy T.
112 Sakallaris BR, Halpin LS, Knapp M, Sheridan MJ. Same-day The development of a stroke clinical pathway: an experience
transfer of patients to the cardiac telemetry unit after in a medium-sized community hospital.Joumal ofMissouri
surgery: the Rapid after Bypass Back into Telemetry State Medical Associatiol1 2000; 41: 648-53
(RABBIT) program. Critical Care Nurse 2000; 20: 50-5, 130 Gilmour C, Twining S. Postnatal care in hospitals: ritual,
59-63,65-8 routine or individualized. AustralianJourJlal of Midwifery
113 Vitaz T\XI, Mcllvoy L, Raque GH, Spain D, Shields CB. 2002; 15: 11-15
Development and implementation of a clinical pathway for 131 Wong C,Visram F, Cook D, Griffith L, RandallJ, O'Brien 13,
severe traumatic brain injury.jollYllal ojTraulllatology 2001; 51: et al. Development, dissemination, implementation and
369-75 evaluation of a clinical pathway for oxygen therapy. Canadian
114 Vitaz TW, McIlvoy L, Raque GH, Spain DA, Shields CB. Medical Associatioll Journal 2000; 162: 29-33
Development and implementation of a clinical pathway for 132 Naglie IG,Alibhai SM. Improving outcomes in hip fracture
spinal cord injuries.JourJlal of Spinal Disorders 2001; 14: patients: are care pathways the answer' JOllrJlal of
271-6 Rhcumatology 2000; 27: 2068-70
115 McIlvoy L, Spain DA, Raque G,Vitaz T, Boaz 1', Meyer K. 133 Hammond JJ. Protocols and guidelines in critical care:
Succesful incorporation of the Severe Head Injury development and implementation. Current Opinion Oil
Guidelines into a phased-outcome clinical pathway.Joumal of Critical Care 2001; 7: 464-8
Ncurosticncc 2001; 33: 72-8 134 Labaw C, Kight L. Following the path to improved
116 Thomas N, Bernard Y. Pediatric simple open heart surgery outcomes. Hospital Case Manaccincnt 2000; 8: 151-4
critical pathway. Hospital Case Manaocmcnt 2001; 9: 55, 58, 50 135 Robotham M, Cro S. Are integrated care pathways suitable
117 Perigard R, Watts K. Hospital uses scan form to integrate for maternity care' Nursino Times 2001; 97: 20
pathways and improve quality. Pathways focus on phases of 136 DeMonaco HJ. Guidelines, pathways, and the end result.
care. Hospital Case Manaocmcnt 2002; 10: 113-7 Critical Carc Medicine 2000; 28: 889-90
118 McIlvoy L, Meyer K,Vitaz T. Use of an acute spinal cord 137 Blumenthal C. Implementing clinical pathways in a small
injury clinical pathway. Critical Care Nlmil1g Clinics of North agency: surviving IPS and preparing for PI'S. HOllie
Ameriw 2000; 12: 521-30 Hcalthcare Nurse Manaocmcnt 2000; 4: 19-25
119 Zevola DR, Raffa M, Brown K. Using clinical pathways in 138 Johnston pA, Ferraro CA. Application of critical pathways in
patients undergoing cardiac valve surgery. Critical Carc Nurse the maternity nursing orientation process.Jolmral of Nurses

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015

 Journal if 105

Staff Dcvision 2001; 17: 61-6 minimize OB complications. Hospital Case Management
139 Dickinson C, Noud M, Triggs R, Turner L,Wilson SN. The 2000;8:7-10
antenatal ward care delivery map: a team model approach. 150 Wilkinson G, Parcell M, MacDonald A. Cerebrovascular
Australian Healtli ReFiCII12000; 23: 68-77 accident clinical pathway.jollYlial 4 Quality Clinical Practice
140 Cannon CP, Hand MH, Bah I' R, Boden WE, Christenson R, 2000;20: 109-12
Gibler WB, ct al. Critical pathways for management of 151 Evcry NR, Hochman J, Becker R, Kopecky S, Cannon CP'
patients with acute coronary syndromes: an assessment by Critical pathways: a review. Committee on Acute Cardiac
the National Heart Attack Alert Program. AlIlericall Heart Care, Council Clinical Cardiology, American Heart
[ournat 2002; 143: 777-89 Association. Circulation 2000; 101: 461-5
141 Russell AS. Are care pathways the answer? [ournal of 152 Kercsmar CM, Myers TR. Clinical pathways in treatment of
Rhcu11latolom' 2001; 28: 2361-2 asthma. Current Opinion 011 Allelgy mid Clinical ItlllllllllOlogy
142 Gibbon B,Watkins C, Barer D,Waters K, Davies S, 2002;2: 183-7.
Lightbody L, ct al. Can staff attitudes to team working in 153 Clary L, Bowles 0, Goforth C. Template for improved
stroke care be improved? [ournal of Advanced Nursing 2002; managcment of chronic discase pays off in asthma effort.
40: 105-11 Cli/lieal Resource Mauaocntcnt 2002; 3: 54-7, 49
143 Clarke LK. Pathways for head and neck surgery: a patient- 154 Jordan P, Hadcock W, Beaulieu C, Karnada S,Vomacka J,
education tool. Clinical [ourna! 4 OIl((Jloc~)' Nursillg 2002; 6: Garrett D, et al. Dccreasing process variation in the care of
18-82 carotid endarterectomy patients. Tilp Health It!«>rIllatioll
144 Middleton E Hands-on nursing and carepaths: a Mauaocr 2001; 22: 24-34
commentary. Australian Health Review 2001; 24: 14 155 Haspeslagh M,Vanhaecht K, De Witte K, Sermeus W,Van de
145 Iedema R, Degeling P Quality of care: clinical governance Waeter'lV, Serra F. Ontwikke1en en testen van een
and pathways. Australian Health Review 2001; 24: 12-5 instrument voor het meten van teameffectiviteit in het kadcr
146 Atwal A, Caldwell K. Do multidisciplinary integrated care van klinische paden. Acta Hospitalia 2002; 3: 117-22
pathways improve interprofessional collaboration' 156 Gittell JH. Coordinating mechanisms in Care Provider
Scandinavian journal of Carillg Science 2002; 16: 360-7 Groups: relational coordination as a mediator and input
147 Sweeney An, Flora HS, Chaloner EJ, Buckland J, Morrice C, uncertainty as a moderator of performance effects.
Barker SG. Integrated care pathways for vascular surgery: an Manaoctucut Science 2002; 48: 1408-26
analysis of the first 18 months. Postgraduate Mcdicin« [ourua! 157 Chen AY, Callender D, Mansyur C, Reyna KM, Limitone E,
2002;78: 175-7 Goepfert H. The impact of clinical pathways on the practice
148 Siddins M.Why aren't clinicians caring about carepaths? A ofhcad and neck oncology surgery: the University ofTexas
commentary. Australian Health Review 2001; 24: 9-13 MD.Anderson Cancer Center Experience. Archives of
149 Peck C, Schriefer J. Parent to Parent Program paths OtolarYllgolog)' Head Neck SllIgery 2000; 126: 322-6.

Downloaded from icp.sagepub.com at Mount Royal University on July 17, 2015