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Integrated care pathways
– identified as a tool to assist the quality of clinical
processes. By promoting evidence based medicine and auditing
its effectiveness, in a constantly changing clinical
environment- are attracting considerable interest in the
U.K. as the national health service (nhs) balances cost
effective use of resources with consumers’ expectations of
healthcare quality.(1)
An integrated
care pathway, is multidisciplinary outline of anticipated
care, placed within an appropriate time frame to help a
patient with a specific condition./set of symptoms move
progressively through a clinical experience to positive
outcomes(2)
This outline derives from :
‘evidence based practice’, described as: the ‘conscientious,
explicit and judicious use of current best evidence in
making decisions about the care of individual patients(3)
It also derives
inputs locally from the multidisciplinary teams to outline
the course of care.
ICPs plot out
the optimal anticipated sequence and timing of interventions
by physicians, nurses, and other professionals for a
particular diagnosis or procedure and against this, the
actual care given is documented by the whole team. The
document is process based – tasks to be done’, and outcome
based – outcomes to be achieved.
While the ICP acts as the template of the care to be
provided, it is not intended to compromise clinical judgment.
Any member of the clinical team can deviate from the
pathway if there is a valid reason for doing so. In essence
the pathway if there is a valid reason for doing so. In
essence the pathway asks each clinician to determine whether
each defined intervention is appropriate for a given
patient, thereby promoting clinical freedom based on the
needs of the individual(2)
A subsequent
analysis of these variations provides invaluable input, not
only for the prospective patient treatment thus minimizing
clinical risks, but also if the pathway itself needs to be
modified to incorporate the changes in the long run. Icps
are dynamic documents and change is to be expected as new
evidence, clinical guidelines and treatment patterns
emerges.
ICPs can be
complex, considered, that given any particular set of
symptoms, no patient is clinically identical , nor responds
in the same way to treatment.
Although steps
to manage 'common variations’ are incorporated within the
main ICP document yet this list cannot be exhaustive.
Given the
scenario, that there are two patients, being managed as per
the ‘stroke’ ICP and of these, one has limb trauma
coupled with stroke, and the other has a history of
diabetes, for both case the ‘outcomes’ of the action taken
example history of the patient shall guide the
multidisciplinary team. On the variation in care, depending
upon individual condition. If the hospital has also
developed ICPs on diabetes/trauma management, those
documents can be referred to, at relevant points.
The
benefits of ICPs in a nutshell
-
Minimize
delays, maximize quality of care
-
Provide
co-ordinated and consistent care
-
By
providing explicit standards, help reduce unnecessary
variations in patient care eg. delimiting the
diagnostic tools required.
-
Provide a
visual representation of the care plan.
-
Improve
communication between the clinical team, as the holistic
care given is documented on a single record
-
Care
pathway can be coasted to achieve the most cost effective
way of treatment in conjunction with the best practice
norms.
-
Clinical
audit of the variances can be undertaken to determine
their impact on the out comes of and thus improvise the
existent pathways
ICPs can also
be a god send for copra cases, where it is vital to document
all the information and if this is done against the current
best practice norms, and ‘accounted for’ variations, there
would be little to worry about.
References:
1) NHS
Executive(1995) Annual Report 1994/95 London: NHSE
2) Middleton
S, Roberts A. Clinical Pathways Workbook.
Wrexham:vfmunit,1998;6.
3) Coulter
A(1996)Promoting Clinical Effectiveness, London: kings Fund
Institute (Newsletter, spring 1996)
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