Elements for Successful Clinical Pathway Development and Maintenance Identified

As pathways become more ingrained in the everyday care of patients with various diseases, Andrew R Bunchert, MD, and Gabriella A Butler, MSN, RN, health care professionals at the Children’s Hospital of Pittsburgh (Pittsburgh, PA), have presented the elements for successful clinical pathway implementation and maintenance.

In an article published in Pediatric Clinics of North America, the authors outline 5 key attributes of successful clinical pathways: (1) that they be interdisciplinary and multidisciplinary; (2) that they be applicable across the entire continuum of care; (3) that they channel guidelines and evidence; (4) that they include measurements beyond outcomes; and (5) that they align with the strategic objectives of the institutions.
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Using this as a functional definition for clinical pathways ensures that they always incorporate different specialties in their development and upkeep, encourage high-quality care throughout a patient’s treatment, are based on the most up-to-date evidence, and account for the possibility that instances may arise in which the care patients require falls outside what is designated on a clinical pathway.

In doing so, pathways can help propel institutional goals of reducing the variability of health care that contributes to unneeded or redundant procedures, drives up costs for patients and institutions, and does nothing to improve outcomes, the authors wrote. 

To produce these far-reaching benefits for patients, physicians, and organizations, these same stakeholders will need to be involved in the development and facilitation of clinical pathways. Hospital staff and executive leadership need to provide the budgets and resources developers need to make and maintain pathways that help patients and improve hospital efficiency. And nurses and physicians need to buy in and adhere to these programs at the point of care while also being actively involved in tracking patient outcomes to identify areas in need of improvement.

Still, even after there is buy-in from different stakeholders, there can be challenges to pathway implementation, the authors wrote. Because pathways need to be developed by a diverse group of professionals, it can sometimes be difficult for those groups to form a consensus. In such a case, it may be necessary to include points of diversion within a pathway that account for varying perspectives.

In addition, sustaining pathways and ensuring that they are based on the most current evidence is vital but also difficult, especially when research is being published so frequently. A dedicated front-line staff committed to reviewing literature can help to make sure that pathways remain current and that all stakeholders remain up-to-date on any changes. 

At the very least, pathways must incorporate buy-in and support from all levels of the organization as well as a feasible ability to continually measure all aspects of the pathway. 

The authors conclude that pathways have the potential to help health care institutions drive high-value care and represent what the authors believe could, “represent the future of health care delivery.”—Sean McGuire 

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Buchert AR, Butler GA. Clinical pathways: driving high-reliability and high-value care. [Published online ahead of print March 24, 2016]. Pediatr Clin North Am. doi:10.1016/j.pcl.2015.12.005.