Clinical Pathways
Clinical Pathways
Clinical Pathways
Definition
A (Clinical Pathway) is an optimal sequencing and timing of interventions by physicians, nurses, and other staff for a particular diagnosis or procedure; it is designed to minimize delays and resource utilization.
Definition
It is a 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).
How Developed?
Typically, a multi-disciplinary task force/committee of knowledgeable stakeholders (physicians, nurses, and ancillary staff) is convened to answer the question, What must be done to the patient, and when must it be done? The task force/committee charged with pathway development considers procedural schedules, targeted lengths of stay, expected outcomes, and excepted costs.
Variances
If a patient does not achieve an expected outcome, a variance occurs. Clinical pathways help in monitoring of variances in outcomes, thus providing feedback for pathway modification. When variance occurs, the physician-incharge is responsible for calling a meeting of the interdisciplinary team to discuss the variance and re-work the pathway.
Variances
Variances are categorized as patient-, system-, or clinician-caused, depending on the source of the variation. For example, in the case of a post-operative patient who should have been scheduled to receive antibiotics according to the clinical pathway, the variance may be generated from any of the three sources: the patient may not tolerate the medication; the system may not be recommending giving the antibiotic in a timely manner; or the clinician may forget to order a medication.
Variances
It is not only essential to identify when a variance occurs but also to hypothesize why the variance occurred in order to determine corrective/preventive actions that can be implemented. The early identification and immediate corrective actions for variances is crucial for providing the appropriate care for individual patients. The variance analysis process requires that each outcome be evaluated along with the process and the structure that support it.