The knowledge base for clinical pathways: a temporary review
Mapping review
|Updated
Key message
The regional health authority formerly known as Helse Øst requested in January 2007 an evaluation of different tools for the improvement of care processes and patient journeys. The hospital Sykehuset Telemark made a similar request in May. This memo gives a temporary answer to the questions in the requests related to clinical pathways. Clinical pathways have been utilized to a greater or lesser degree in Norwegian hospitals and are now prioritized in the strategies of Helse Sør-Øst.
Clinical pathways can be defined as “structured multidisciplinary care plans which detail essential steps in the care of patients with a specific clinical problem”. Clinical pathways are utilized to support the implementation of clinical practice guidelines, and with the intention to improve coordination of care, length of stay and to reduce costs.
We searched for systematic reviews about the effect of clinical pathways, focusing on reviews about the effect of clinical pathways in general. The search also identified systematic reviews about the use of clinical pathways in specific clinical conditions, and reviews in related and relevant fields. Our examination of the evidence has obvious methodological weaknesses due to the simplified method applied, both concerning the identification and the lack of appraisal of the quality of the reviews.
We identified one Cochrane protocol and two systematic reviews about the effect of clinical pathways in general. The systematic review based on the Cochrane protocol is due in June/July 2008 and will most likely give a good overview of the knowledge base for clinical pathways. The conclusions of the two finished reviews are partly contradictory and of uncertain quality.
We identified eight systematic reviews about the effect of clinical pathways within specific, clinical fields. These reviews are contradictory and encompass positive effects, negative effect, moderate/small effect, uncertain effect and effect in a limited number of situations.
Three reviews deal with related and relevant fields, respectively the effect of nursing record systems and reviews of appraisal/audit tools for clinical practice guidelines and clinical pathways.
Clinical pathways can be relevant regarding the concept of evidence-based practice by connecting the work tied to clinical pathways to the best available knowledge. This concerns which areas a hospital tries to improve by using clinical pathways, what research and guidelines the clinical pathways are based upon, and how they are produced and implemented. We give some brief information about some resources and tools that might be relevant.
Our review indicates that the knowledge base concerning the effect of clinical pathways is incomplete. A good overview will probably be available with the upcoming Cochrane review according to the plan in June/July 2008.
Employing clinical pathways can be regarded as an experimental activity, given the lack of evidence about their effect. Connecting clinical pathways to evaluation and research could contribute to more knowledge, including knowledge of effects. The existing Cochrane protocol and several of the systematic reviews warn against spending additional resources on developing and implementing clinical pathways before a rigorous evaluation of the effect and effectiveness has been undertaken.