Clinical Pathway

Clinical Pathways (Care Pathways, Critical Pathways, Integrated Care Pathways, 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.

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 (Boston,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:
*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.

election Criteria

* 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

ee also

* European Pathway Association (EPA)
* Evidence Based Medicine
* Nursing care plan
* Health economics

References

* [http://perswww.kuleuven.be/~u0035350/00000097390f70c01/00000097390f92209/00000097391054203/index.html History of Clinical Pathways]
* Karen Zander and Kathleen Bower, "Nursing Case Management, Blueprint for Transformation", 1987
* Virginia Maturen and Lisa Van Dyck, Home Health Care Management & Practice, "Using Outcome-Based Critical Pathways to Improve Documentation", 1996
* Anthony Jerant and Rahman Azari, "Home Health Care Services Quarterly", A Randomized Trial of Telenursing to Reduce Hospitalization for Heart Failure: Patient-Centered Outcomes and Nursing Indicators, 2003
* The Value of Clinical Pathways in Homecare "Caring". 1997 Jun;16(6):42-4, 46.
* Meister, S.et al. "Journal of Nursing Administration", Home Care Steps Protocols: Homecare's Answer to Changes in Reimbursement. 1995 Jun;25(6):33-42

External links

* [http://www.library.nhs.uk National Library for Health] (UK)
* [http://www.e-p-a.org European Pathway Association]
* [http://www.viasclinicas.com Viasclinicas] (Spanish)
* [http://www.nkp.be/00000095de0808c10/index.html Belgian Dutch Clinical Pathway Network]