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WHAT IS AN INTEGRATED CARE PATHWAY?

Definition

An Integrated Care Pathway is an interdisciplinary plan of care, which outlines the optimal timing and sequencing of of interventions for patients with a particular diagnosis.

Where did the idea of ICPs come from?

The idea originally came from the USA in the 1980's. Until then the delivery of healthcare had been fragmented, characterised by

  • Long length of stay in hospital
  • Variable practice among clinicians
  • Sometimes unnecessary use of resources
  • Uncoordinated discharge planning
  • Poor continuity of care

    The idea of standardising patient care using protocols was introduced to improve the quality of care, to contain the cost of care (in the USA) and as a tool for implementing clinical governance (in the UK).

    What are the main features of an ICP?

    All ICPs include the following 4 features:

    • A statement of desired outcome, or goal
    • A timeline for sequencing interventions
    • Interdisciplinary collaboration
    • Inclusion of comprehensive aspects of care

    Give examples of these 4 features.

  • Outcomes or goals may be daily, weekly or discharge goals. Eg 'Patient will remain continent of urine today' or 'Patient will be able to walk 10 metres with a stick, by the time of discharge'

  • Timeline will specify the timescale for particular interventions.Eg A table will indicate the appropriate laboratory and radiological tests for the first 5 days of admission

  • Interdisciplinary collaboration is jointly developed by multiple healthcare professionals.Eg the plan for continence management is developed by the doctor and the nurse working together to combine the information from the doctor's diagnosis and the nurse's 24-hour monitoring, to arrive at the optimum plan; or the physio and occupational therapist work together in developing the patient's wheelchair mobility plan.

  • Comprehensive aspects of care include items of care which are tracked throughout the admission, such as nutrition, diagnostic tests, teatment, mobility, patient and carer teaching and discharge planning.

    What about patients whose illness does not go according to the plan?

    All patients with a particular diagnosis are started on the 'generic' pathway for that condition.

    For those who develop complications a variance record is created. This is kept alongside the generic pathway and allows the clinicians to document the complications fully, still keeping the guidelines for the main condition in mind.

    Why use an Integrated Care Pathway?

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    Copyright ©Nikki Devitt 2002, on behalf of the WAHT Stroke Pathway Group

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    Date of last review: 25th April 2002

    Date of next review:25th October 2002