 Clinical Pathways

 Framework for Clinical Pathways

 Benefits.
 Pathway Development Teams
 Clinical Practice Guidelines
 Evaluation of the CPGs
 Algorithms
 CPGs and Clinical Pathways Comparison.
 A Care Pathway is a multi-disciplinary plan of care
that blends patient needs, quality outcomes, and
controlled costs, with predetermined standards of
care using a replicable process.
 Many synonyms exist for the term Clinical Pathways
including: Integrated Care Pathways,
Multidisciplinary pathways of care, Pathways of
Care, Care Maps, Collaborative Care Pathways.
 Clinical Pathways were introduced in the early 1990s in the
UK and the USA, and are being increasingly used throughout
the developed world.
 Clinical Pathways are structured, multi-displinary plans of
care designed to support the implementation of clinical
guidelines and protocols.
 They are designed to support clinical management, clinical
and non-clinical resource management, clinical audit and
also financial management.
 They provide detailed guidance for each stage in the
management of a patient (treatments, interventions etc.) with
a specific condition over a given time period, and include
progress and outcomes details.
 Clinical Pathways aim to improve, in particular, the continuity
and co-ordination of care across different disciplines and
sectors.
Clinical Pathways have four main components
(Hill, 1994, Hill 1998):
A timeline.
The categories of care or activities and their
interventions.
Intermediate and long term outcome criteria.
Pathways have several benefits to an organization:
Improve Clinical and Financial Outcomes
Improve Quality and Coordination of Care
Support the introduction of evidence-based medicine and use
of clinical guidelines
Improve multidisciplinary communication, teamwork and care
planning
Help reduce variations in patient care (by promoting
standardization).
Reduce Practice Variation, Increase Usage of Best Practices
Can support continuity and co-ordination of care across
different clinical disciplines and sectors.
 Assemble multidisciplinary teams.
 Define clinical problems and current practice.
 Conduct literature search
 Describe and classify research according to

levels of evidence.
 Formulate guideline recommendations
 Link guidelines to form clinical pathways.
 The Institute of Medicine defines CPGs as
“systematically developed statements that assist
practitioner and patient decisions about
appropriate health care for specific clinical
circumstances". Field & Lohr,1992;Candian Medical
Association,1994)
 Guidelines may be based on expert
opinion/Consensus and/or evidence based practice
as identified by research and may be regional,
program based, unit specific, or based on case
types.
 CPGs offer recommendations for care and are
prescriptive in nature, helping the practitioner
determine the appropriateness of selected
interventions.
 Official statement or policies for proper care .
 CPGs could be EBP based or non- EBP based.
 CPGs may be referred to as practice parameters,
practice policies and appropriateness criteria.
Ankle X-ray series is required only if there is pain
in the malleolar Zone and any one of the following:
1. Bone tenderness along the distal 6cm of the
posterior edge of the fibula or tip of the lateral
malleolus.
2. Bone tenderness along the distal 6cm of the
posterior edge of the tibia or tip of the medial
malleolus.
3. Inability to bear weight for four steps, both
immediately and in the emergency department.
 Algorithms are “Written guidelines to
stepwise evaluation and management
strategies that require observations to be
made, decisions to be considered, and
actions to be taken”.
(Hadorn,McCormick,&Diokno,1992)
 Algorithms are simply CPGs arranged in a

decision-tree format.
 A list of well-defined instructions for

completing a task.
This is an algorithm that
tries to figure out why the
lamp doesn't turn on and
tries to fix it using the steps.
Flowcharts are often used
to represent algorithms
graphically.
CPGs& Algorithms: Clinical pathways
Focus on operationalizing
 Focus on identifying
options.
best clinical option. Setting/institution specific;
 Useful across clinical
tailored to fit local
Settings, apply conditions.
generally. Require multi or trans-
 May or may not be disciplinary approach based
provider specific. on evidence.
 Based on evidence, Produced by a

expert opinion or multidisciplinary team.

consensus