What Are Pathways Programs
Clinical guidelines and consensus statements developed to assist in clinical management decisions, and clinical pathways are tools to manage quality outcomes and cost of care based on clinical guidelines and current evidence—(Evidence-based Medicine). Clinical pathways are document-based tools that provide a link between the best available evidence and clinical practice. Clinical pathways, also known as care pathways, integrated care pathways, care maps and critical pathways, are one tool used to manage the quality in healthcare concerning the standardization of care processes. A variety of terms are used for this tool. For simplicity, the term clinical pathway is used in this article.
Clinical Pathways in the Healthcare Setting
Clinical pathways support EBM and clinical guidelines in a time-oriented plan. The use of pathways or guidelines reduces variation of clinical practice to optimize patient outcomes. Clinical pathways operationalize evidence into daily practice for patient care. They are intended to create an integrated comprehensive approach or plan to the patient’s care rather than individual professionals functioning independently. Interdisciplinary communication, collaboration, and teamwork are enhanced by working from one pathway, and continuity and care coordination are achieved for the patient.
Pathways and Outcomes
The pathway shapes expectations or outcomes of care as the patient progresses, based on what is the best practice for most patients for most of the time. The pathway is written in a manner to ensure that actions or interventions are completed at designated points with the expected outcome. They are designed to support clinical management, clinical and nonclinical resource management, audit management, and financial management. Often, the improved clinical outcomes are intended to support cost-effective use of resources such as length of stay, diagnostic tests, and pharmaceutical management.
Outcomes and Variance
Because there are differences in responses for the same condition or treatment, individual variances must be captured, documented, and addressed. The continuous monitoring and data evaluation component is essential to pathway improvement through continual revision of pathways. It is expected that over time variation decreases through standardization, costs decrease, and the value of care improves.
Pathways tend to address processes in the ideal or uncomplicated patient and may not address problems in most patients. It is important to identify which patients are appropriate for a particular pathway. In general, pathways are more applicable to patients with uncomplicated illnesses undergoing procedures or surgery.
Pathways and the Patient
The standardization approach is designed to empower patients such that each patient knows the plan and his/her/their expected outcome at each phase of the recovery. Standardization reduces clinical risk by ensuring that for specific conditions there are no lapses in care to be provided. If outcomes are not met, there should be an immediate assessment of the reason.