In today’s world, processes and practices for providing medical care vary from one facility to another. One facility discharges its patients faster, but another has fewer readmissions for acute care. One doctor orders this test, and another doctor orders that test—both for assessing the same condition. Shouldn’t we be able to expect consistent best practices from the healthcare system in the United States?
Enter clinical pathways (CPWs). CPWs offer a way to standardize care that results in the best possible outcomes. Studies have found that the use of CPWs results in fewer hospital complications, improved professional documentation, and a reduction in costs.1 Sounds too good to be true—it must be difficult to implement, right? Fortunately, healthcare organizations don’t need to reinvent the wheel in order to take advantage of CPWs. Let’s examine some frequently asked questions that can help us begin moving towards the implementation of CPWs.
What Are Clinical Pathways?
CPWs are evidence-based interdisciplinary plans of care implemented for a group of patients with a specific condition. CPWs aim to standardize care from healthcare worker to healthcare worker and facility to facility, while being flexible enough to allow individualization. CPWs are used to translate evidence-based guidelines into a workable plan for use at the bedside and define specific steps in a course of treatment, with appropriate time-frames and expected outcomes.
CPWs started to become popular in the 1980s, and facilities and clinicians have gradually adopted them over time.2 You’ve likely seen and worked with pathways for prevention of conditions like deep vein thrombosis and pneumonia, treatment of asthma and heart failure, or discharge from the recovery room of a surgical center.
Who Develops Clinical Pathways?
CPWs come in many shapes and sizes, and can be developed in a number of ways. Some are “home-grown” from a specific facility or group of facilities, while others are developed by professional organizations. Many CPWs come from reputable groups such as the American Heart Association or the American Diabetes Association. CPWs can be adapted to suit the needs of different regions and patient populations, and they are expected to be valid, reliable, and evidence-based.
Why Should We Use Clinical Pathways?
CPWs help us standardize care, ensure care is evidence-based, and improve outcomes.3 CPWs help guide us to what is current, what is best practice, and how we should be delivering care. All teams should consider adopting and adapting current CPWs in order to improve their care and support the success of their facilities and health and healing of their patients.
How Do I Get Started?
To get you started, here are a few links to help your team locate current CPWs. If your care is currently CPWs, you can use these as a springboard to discussion with the team and administrators.
Here are some resources to aid in the development of successful CPWs:
Clinical Pathways – Johns Hopkins All Children’s Hospital
Therapy – Clinical Mapping Tool
Northwestern Medicine – Protocols and Pathways: Ischemic and Hemorrhagic Stroke
Clinical Pathways – Children’s Hospital Colorado
Ultimately, the care we offer to our patients is about quality and results. CPWs can help us improve our care, ensure it is evidence-based, and provide best practices that improve outcomes for our patient populations. Our patients expect and deserve the best we can offer. CPWs help make that possible.
- Rotter T, de Jong RB, Lacko SE, et al. Clinical pathways as a quality strategy. In: Busse R, Klazinga N, Panteli D, et al., editors. Improving healthcare quality in Europe: Characteristics, effectiveness and implementation of different strategies [Internet]. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2019. (Health Policy Series, No. 53.) 12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549262/
- Morri, M., Forni, C., Guberti, M., Chiari, P., Pecorari, A., Orlandi, A. M., Gazineo, D., Bozzo, M., & Ambrosi, E. (2021). Post-hospital care pathway for individuals with hip fracture: what is the optimal setting and rehabilitation intensity? An observational study. Disability and rehabilitation, 1–8. Advance online publication. https://doi.org/10.1080/09638288.2021.1897692
- Lawal, A. K., Rotter, T., Kinsman, L., Machotta, A., Ronellenfitsch, U., Scott, S. D., Goodridge, D., Plishka, C., & Groot, G. (2016). What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review. BMC medicine, 14, 35. https://doi.org/10.1186/s12916-016-0580-z