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CLINICAL PATHWAYS

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Hrishikesh Kakde

Clinical pathways provide a standardized, multidisciplinary care plan for specific diagnoses or procedures. They outline key steps, interventions, and expected outcomes for patients' hospital stays. Developing clinical pathways requires input from physicians, nurses, and other healthcare professionals to establish best practices based on evidence and optimize resource utilization and quality of care. Nurses play an important role in following the clinical pathway for patients, informing the team of any variances, and collaborating with other professionals.

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CLINICAL PATHWAYS
1. Concept and historical background of the concept 2. Objectives of CP 3. Characteristics of CP 4. Importance of CP in nursing 5. Steps in developing and implementing CP Learning Outcomes
Concept • The application of computers to generate, validate, secure and integrate healthcare data to support the decision making activities of clinical and ad ministrative professional has added an entirely new dimension to the func tioning of healthcare industry. • Techniques of Quality Management Science are among the newer appro aches to managing the delivery of healthcare. One such application of this science to healthcare is Clinical Pathways. • Successful case management relies on critical pathway to guide care • Critical pathway refers to the expected outcomes and care strategies dev eloped by collaborative practice team. Collaborative practice is an approach that enables health care pr oviders to deliver high quality, safe person-centred services to a chieve the best possible individual health outcomes
Skills for collaborative work • Have a common purpose and goal. • Trust each other. • Clarify their roles from the start. • Communicate openly and effectively • Appreciate a diversity of ideas. • Balance the team focus. • Leverage any heritage relationships. Case Management: Case management nurses are registered nurses who coordinate all aspects of the care of individual patients. They ensure proper utilization of services and resources as well. Case managers provide assistance within, between, and outside of facilities. • Share a vision. • Set expectations early. • Establish metrics. • Capitalize on strengths. • Encourage new ideas. • Create cross-functional work groups. • Keep your promises. • Build team relationships after work.
CP: Definition 1. Critical paths are guides that outline the critical or key ev ents expected to happen each day of patient’s hospitaliza tion -Cohen & Cesta,2001 2. Critical pathways are one method of planning, assessing, i mplementing and evaluating the cost- effectiveness of pat ient care 3. A series of methods and instruments to align member of the interdisciplinary and interprofessionally team for the c are of the pre defined patient population in order to reali ze an efficient, patient centered, coordinated program of care
Synonyms • Anticipatory recovery pathways (ARPs) • Integrated Care Pathways, • Multidisciplinary pathways of care ( MPCs), • Pathways of Care, • Care Maps, • Collaborative Care Pathways • Critical Pathway • Anticipated Recovery Path • Managed care plans • Care track • Care Profiles
History The concept of critical pathways is borrowed from the theories of Continuous Quality Improvement (CQI). Critical pathways are first developed for the use in industry as a t ool to identify and manage the rate limiting steps in production pr ocesses. In health care, critical pathways were first developed and applied in 1980s to improve hospital efficiency. Most of the first critical pathway in the hospital are develop by nu rses for nursing care alone. Later on these have been developed by other disciplines covering all the aspects.
FEATURES • Predetermined course of progress • Variance analysis • Fiscal planning • Directing • Orientation • Identifies outcome • It should be structured multidisciplinary care plan. It supports multidisciplinary ca re and evidence based clinical practice. • The goal and key elements of care based on evidence and best practice should be defined and stated. • It should guide the management for a well-defined group of patients for a well-defi ned period of time. • It sequences the action of multidisciplinary team. • It facilitates variance managements and allows documenting, monitoring and evalua ting the variance. • The essential step in care of patients with specific clinical problem is detailed. • It should help communication with patient by providing a clearly summary of care.
WHAT DOES IT CONTAIN? • Specific medical diagnosis • The expected length of stay • Patient identification data • Appropriate time frames (in days, hours, minutes or vis its) for intervention • Patient outcomes • Interventions presented in modality groups ( medicatio ns, nursing activity & so on) • Nursing diagnosis
Why Clinical Pathways? • To improve patient care • To maximize the efficient use of resources • To help identify and clarify the clinical processes • To support clinical effectiveness, clinical audit and risk management • Eliminate prolonged lengths of stay arising from inefficiencies, allowi ng better use of resources • Reduce mistakes, duplication of effort and omissions • Improve the quality of work for service providers • Improve communication with patients as to their expected course of treatment • Identify problems at the earliest opportunity and correct these prom ptly • Facilitate quality management and an outcomes focus
Objectives • Selecting a best practice when practice style varies unnecessarily. • Defining the standards for the expected duration of hospital stay an d for the use of tests and treatment. • Examining the interrelations among the different steps in the care pr ocess to find ways to co-ordinate or decrease the time in the ratelimit ing step. • Giving all hospital staff a common game plan from which to view an d understand their various role in the overall care process. • Providing a framework for the collecting data on the care process so that providers can learn how often and why patients do not follow an expected course during their hospitalization. • Decreasing documentation burden. • Improving patient satisfaction with care by educating patients and t heir families about the plan of care.
Benefits • Improve patients care. • Increase use of recommended medical acre. • Decrease use of unnecessary tests. • Decrease increase lengths of stay of patients. • Reduce costs. • Increase participation in clinical research protocols.
Critical pathway professional • Physician • Nurse manager • Staff nurse • Social worker • Dietician • Occupational therapist • Pharmacist
Clinical Pathway Development PREREQUISITE: • Succeed when the decision to develop is taken on an organiza tional basis. • Senior management commitment and a strong medical and n ursing lead are essential • Pathway documentation is more likely to be used if it is simple , clear and user friendly • The process of pathway development considers why tasks and interventions are performed, and by whom; since it promotes gr eater awareness of the role of each professional involved in the care cycle.
Basis of Critical Pathway Technique • Define the processes • Timing of these processes, • Note target areas that were critical, • Measure variation, and make improvements • Re-measurement.
Guidelines for the Development and Implementation • Educate and obtain support from physicians and nurse, and establish a multidisciplinary team. • Identify potential obstacles to implementation. • Use Quality improvement methods and tools. • Determine staff interest and select Clinical Pathways to dev elop. • Collect Clinical Pathway data and medical record reviews of practice patterns. • Conduct literature review of clinical practice guidelines. • Develop variance analysis system and monitor the complian ce with documentation on Clinical Pathways. • Use a pilot Clinical Pathway for 3 to 6 months; revise as ne eded.
Constituents of Clinical Pathways • Multi-disciplinary, multi-agency, clinical and administrative a ctivities • Structured Variance Tracking • Local and National standards • Evidence based, locally agreed, best practices • Tests, charts, diagrams, information leaflets, satisfaction que stionnaires, etc. • Scales for measurement of clinical effectiveness • Outcomes • Freehand notes • Scalability to add activities to a standard CP for individualiz ed care for a particular patient • Problem, Plan, Goal and Notes or similar structured freehan d area
Limitations of Clinical Pathways • Implementation of the care pathways has not been t ested in a scientific or controlled fashion. • No controlled study has shown a critical pathway to reduce length of stay, decrease resource use, or impro ve patient satisfaction. • Most importantly, no controlled study has shown i mprovements in patient outcome
Barriers to Clinical Pathways • May appear to discourage personalized care • Risk increasing litigation • Don't respond well to unexpected changes in a patient's co ndition • Suit standard conditions better than unusual or unpredicta ble ones • Require commitment from staff and establishment of an ad equate 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 record ed, audited and acted upon.
Challenges faced for Implementation • Difficulties in engaging senior clinicians and persuadi ng them to participate in the procedure of designing a nd implementation of the clinical pathways (e.g. engag ing a cardiologist or neurologist in the process) • Difficulties in engaging junior medical staff because o f their high turn-over, limited free time and heavy clini cal loads • Problems in finding a common meeting time across disciplines, and getting the multidisciplinary staff invol ved in the use of the clinical pathways for the training for their effective use and learning their importance in the clinical practice
What is your role as staff Nurse • Provides patient care • • Follow critical pathway • • Inform any deviance • • Collaborate with other professionals
CLINICAL PATHWAYS
CLINICAL PATHWAYS
Conclusion A Clinical Pathway is thus a ro ad map for a patient as well a s for the treatment team, whic h supports an Effective In-pati ent Care.

More Related Content

CLINICAL PATHWAYS

  • 2. 1. Concept and historical background of the concept 2. Objectives of CP 3. Characteristics of CP 4. Importance of CP in nursing 5. Steps in developing and implementing CP Learning Outcomes
  • 3. Concept • The application of computers to generate, validate, secure and integrate healthcare data to support the decision making activities of clinical and ad ministrative professional has added an entirely new dimension to the func tioning of healthcare industry. • Techniques of Quality Management Science are among the newer appro aches to managing the delivery of healthcare. One such application of this science to healthcare is Clinical Pathways. • Successful case management relies on critical pathway to guide care • Critical pathway refers to the expected outcomes and care strategies dev eloped by collaborative practice team. Collaborative practice is an approach that enables health care pr oviders to deliver high quality, safe person-centred services to a chieve the best possible individual health outcomes
  • 4. Skills for collaborative work • Have a common purpose and goal. • Trust each other. • Clarify their roles from the start. • Communicate openly and effectively • Appreciate a diversity of ideas. • Balance the team focus. • Leverage any heritage relationships. Case Management: Case management nurses are registered nurses who coordinate all aspects of the care of individual patients. They ensure proper utilization of services and resources as well. Case managers provide assistance within, between, and outside of facilities. • Share a vision. • Set expectations early. • Establish metrics. • Capitalize on strengths. • Encourage new ideas. • Create cross-functional work groups. • Keep your promises. • Build team relationships after work.
  • 5. CP: Definition 1. Critical paths are guides that outline the critical or key ev ents expected to happen each day of patient’s hospitaliza tion -Cohen & Cesta,2001 2. Critical pathways are one method of planning, assessing, i mplementing and evaluating the cost- effectiveness of pat ient care 3. A series of methods and instruments to align member of the interdisciplinary and interprofessionally team for the c are of the pre defined patient population in order to reali ze an efficient, patient centered, coordinated program of care
  • 6. Synonyms • Anticipatory recovery pathways (ARPs) • Integrated Care Pathways, • Multidisciplinary pathways of care ( MPCs), • Pathways of Care, • Care Maps, • Collaborative Care Pathways • Critical Pathway • Anticipated Recovery Path • Managed care plans • Care track • Care Profiles
  • 7. History The concept of critical pathways is borrowed from the theories of Continuous Quality Improvement (CQI). Critical pathways are first developed for the use in industry as a t ool to identify and manage the rate limiting steps in production pr ocesses. In health care, critical pathways were first developed and applied in 1980s to improve hospital efficiency. Most of the first critical pathway in the hospital are develop by nu rses for nursing care alone. Later on these have been developed by other disciplines covering all the aspects.
  • 8. FEATURES • Predetermined course of progress • Variance analysis • Fiscal planning • Directing • Orientation • Identifies outcome • It should be structured multidisciplinary care plan. It supports multidisciplinary ca re and evidence based clinical practice. • The goal and key elements of care based on evidence and best practice should be defined and stated. • It should guide the management for a well-defined group of patients for a well-defi ned period of time. • It sequences the action of multidisciplinary team. • It facilitates variance managements and allows documenting, monitoring and evalua ting the variance. • The essential step in care of patients with specific clinical problem is detailed. • It should help communication with patient by providing a clearly summary of care.
  • 9. WHAT DOES IT CONTAIN? • Specific medical diagnosis • The expected length of stay • Patient identification data • Appropriate time frames (in days, hours, minutes or vis its) for intervention • Patient outcomes • Interventions presented in modality groups ( medicatio ns, nursing activity & so on) • Nursing diagnosis
  • 10. Why Clinical Pathways? • To improve patient care • To maximize the efficient use of resources • To help identify and clarify the clinical processes • To support clinical effectiveness, clinical audit and risk management • Eliminate prolonged lengths of stay arising from inefficiencies, allowi ng better use of resources • Reduce mistakes, duplication of effort and omissions • Improve the quality of work for service providers • Improve communication with patients as to their expected course of treatment • Identify problems at the earliest opportunity and correct these prom ptly • Facilitate quality management and an outcomes focus
  • 11. Objectives • Selecting a best practice when practice style varies unnecessarily. • Defining the standards for the expected duration of hospital stay an d for the use of tests and treatment. • Examining the interrelations among the different steps in the care pr ocess to find ways to co-ordinate or decrease the time in the ratelimit ing step. • Giving all hospital staff a common game plan from which to view an d understand their various role in the overall care process. • Providing a framework for the collecting data on the care process so that providers can learn how often and why patients do not follow an expected course during their hospitalization. • Decreasing documentation burden. • Improving patient satisfaction with care by educating patients and t heir families about the plan of care.
  • 12. Benefits • Improve patients care. • Increase use of recommended medical acre. • Decrease use of unnecessary tests. • Decrease increase lengths of stay of patients. • Reduce costs. • Increase participation in clinical research protocols.
  • 13. Critical pathway professional • Physician • Nurse manager • Staff nurse • Social worker • Dietician • Occupational therapist • Pharmacist
  • 14. Clinical Pathway Development PREREQUISITE: • Succeed when the decision to develop is taken on an organiza tional basis. • Senior management commitment and a strong medical and n ursing lead are essential • Pathway documentation is more likely to be used if it is simple , clear and user friendly • The process of pathway development considers why tasks and interventions are performed, and by whom; since it promotes gr eater awareness of the role of each professional involved in the care cycle.
  • 15. Basis of Critical Pathway Technique • Define the processes • Timing of these processes, • Note target areas that were critical, • Measure variation, and make improvements • Re-measurement.
  • 16. Guidelines for the Development and Implementation • Educate and obtain support from physicians and nurse, and establish a multidisciplinary team. • Identify potential obstacles to implementation. • Use Quality improvement methods and tools. • Determine staff interest and select Clinical Pathways to dev elop. • Collect Clinical Pathway data and medical record reviews of practice patterns. • Conduct literature review of clinical practice guidelines. • Develop variance analysis system and monitor the complian ce with documentation on Clinical Pathways. • Use a pilot Clinical Pathway for 3 to 6 months; revise as ne eded.
  • 17. Constituents of Clinical Pathways • Multi-disciplinary, multi-agency, clinical and administrative a ctivities • Structured Variance Tracking • Local and National standards • Evidence based, locally agreed, best practices • Tests, charts, diagrams, information leaflets, satisfaction que stionnaires, etc. • Scales for measurement of clinical effectiveness • Outcomes • Freehand notes • Scalability to add activities to a standard CP for individualiz ed care for a particular patient • Problem, Plan, Goal and Notes or similar structured freehan d area
  • 18. Limitations of Clinical Pathways • Implementation of the care pathways has not been t ested in a scientific or controlled fashion. • No controlled study has shown a critical pathway to reduce length of stay, decrease resource use, or impro ve patient satisfaction. • Most importantly, no controlled study has shown i mprovements in patient outcome
  • 19. Barriers to Clinical Pathways • May appear to discourage personalized care • Risk increasing litigation • Don't respond well to unexpected changes in a patient's co ndition • Suit standard conditions better than unusual or unpredicta ble ones • Require commitment from staff and establishment of an ad equate 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 record ed, audited and acted upon.
  • 20. Challenges faced for Implementation • Difficulties in engaging senior clinicians and persuadi ng them to participate in the procedure of designing a nd implementation of the clinical pathways (e.g. engag ing a cardiologist or neurologist in the process) • Difficulties in engaging junior medical staff because o f their high turn-over, limited free time and heavy clini cal loads • Problems in finding a common meeting time across disciplines, and getting the multidisciplinary staff invol ved in the use of the clinical pathways for the training for their effective use and learning their importance in the clinical practice
  • 21. What is your role as staff Nurse • Provides patient care • • Follow critical pathway • • Inform any deviance • • Collaborate with other professionals
  • 24. Conclusion A Clinical Pathway is thus a ro ad map for a patient as well a s for the treatment team, whic h supports an Effective In-pati ent Care.