August 2012 - Internet Resources Digest


Clinical pathways

AIHA Internet Resources Digest

Supporting Access to the High Quality Online Resources

August 2012

Spotlight on: Clinical Pathways

Clinical pathways, also known as care pathways, critical pathways, integrated care pathways, or care maps, are one of the main tools used to manage the quality in healthcare concerning the standardization of care processes. “It has been proven that their implementation reduces the variability in clinical practice and improves outcomes. Clinical pathways promote organized and efficient patient care based on the evidence based practice. Clinical pathways can be seen as an application of process management thinking to the improvement of patient healthcare. An aim is to re-centre the focus on the patient's overall journey, rather than the contribution of each specialty or caring function independently.“ 

(From Wikipedia

Selected Organizations Working in the Field

The European Pathway AssociationThe European Pathway Association

A European non-profit organization which brings together researchers, managers and clinicians on the management concept of clinical pathways. It works on the establishment of clinical care pathways in order to systematically plan and follow up a patient focused care program.

The web-site provides information about news, conferences, training courses and publications in the field.

Belgian Dutch Clinical Pathway NetworkBelgian Dutch Clinical Pathway Network

More than 100 organizations are members of the Network (including acute hospital trusts, rehabilitation centres and home care organizations). The Network has three main activities: to provide education on clinical pathways and related concepts; to support multidisciplinary teamwork, in-hospital projects on pathways and multi-centre research projects & benchmarking; research and international collaboration.

OpenClinical. Clinical PathwaysOpenClinical. Clinical Pathways

OpenClinical is a not-for-profit organisation created and maintained as a public service with support from Cancer Research UK under the overall supervision of an international technical advisory board.

OpenClinical has been created to: Promote decision support, clinical workflow and other knowledge management technologies in patient care and clinical research; Disseminate methods and tools for building healthcare knowledge applications that comply with the highest quality, safety and ethical standards; Build a community of individuals, organisations and commercial companies who believe in the value of knowledge management, and who wish to contribute to the definition and adoption of open technical standards for medical applications.

The OpenClinical Web site is aimed in particular at healthcare professionals and managers, medical informaticians and computer scientists and industry. It is designed to be a "one-stop shop" for anyone interested in learning about and tracking developments on advanced knowledge management technologies for healthcare such as point-of-care decision support systems, "intelligent" guidelines and clinical workflow.

Clinical Pathways: multidisciplinary plans of best clinical practice. This section of the Web site discusses care pathways and supporting technologies, their benefits, potential problems and barriers, and provides links to related documents and we-based resources.

NICE PathwaysNICE Pathways

NICE Pathways is for people who use NICE guidance. This includes health and social care professionals, public health experts, those who commission or provide health and social care services, employers and members of the public. NICE Pathways is a useful tool for professionals at any career stage, from learning and training to continuing professional development and keeping up to date.

NICE Pathways is an online tool for health and social care professionals that brings together all related NICE guidance and associated products in a set of interactive topic-based diagrams. Visually representing everything NICE has said on a particular topic, the pathways enable you to see at a glance all of NICE's recommendations on a specific clinical or health topic. They provide an easier and more intuitive way to find, access and use NICE guidance. 

NICE pathways represents a network of NICE information. For example, the diet pathway links up with the physical activity pathway; the COPD pathway links up with the smoking pathway. Over time, all of NICE's guidance, quality standards and related tools will be added to this network of information. 

Each pathway includes all relevant NICE guidance: clinical guidelines, public health guidance, technology appraisals, interventional procedures, medical technology and diagnostics guidance, and quality standards, and accompanying tools produced by NICE to support implementation.

Journals, Presentations & Articles 

IJCPInternational Journal of Care Pathways 

The International Journal of Care Pathways provides a forum for exploring a wide range of issues relating to ICPs. Including implementation, evaluation and strategic issues such as informatics, risk management and quality, the journal contains case studies of ICP programmes, original research articles, debate and commentary, book reviews and conference reports.

The journal focuses on how pathways affect quality, safety, teamwork and efficiency, and the role of patients, carers, health and social care professionals, managers, policy makers and stakeholders, including the purchasers and commissioners of services and those who monitor them for efficiency and effectiveness. 

This journal includes research papers, case studies of CP projects and programs from all over the world. This includes issues relating to the CP itself and to the methodologies and outcomes related to planning, development, implementation and updating, education & training, communication and evaluation. This journal includes news from the European Pathway Association ( and other national and international pathway societies and their conference reports. 

Free abstracts. 30 day personal free trial. Access to full-text through HINARI.

From this page of the journal Web site, you can access six sample Integrated Care Pathways

Critical Pathways in Cardiology: A Journal of Evidence-based Medicine

Critical Pathways in CardiologyCritical Pathways in Cardiology provides a single source for the diagnostic and therapeutic protocols in use at hospitals worldwide for patients with cardiac disorders. The Journal presents critical pathways for specific diagnoses—complete with evidence-based rationales—and also publishes studies of these protocols' effectiveness. 

Free abstracts, and selected articles.  Access to full-text through HINARI. 

Rotter T, Kinsman L, James EL, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD006632. DOI: 10.1002/14651858.CD006632.pub2. 

“Decision-making in hospitals has evolved from being opinion-based to being based on sound scientific evidence. This decision-making is recognised as evidence-based practice. Perpetual publication of new evidence combined with the demands of every-day practice makes it difficult for health professionals to keep up to date.

Clinical pathways are document-based tools that provide a link between the best available evidence and clinical practice. They provide recommendations, processes and time-frames for the management of specific medical conditions or interventions. Clinical pathways have been implemented worldwide but the evidence about their impact from single trials is contradictory. This review aimed to summarise the evidence and assess the effect of clinical pathways on professional practice (e.g. quality of documentation), patient outcomes (e.g. mortality, complications), length of hospital stay and hospital costs.

Twenty-seven studies involving 11,398 participants were included for analysis. The main results were a reduction in in-hospital complications and improved documentation associated with clinical pathways. Complications assessed included wound infections, bleeding and pneumonia. Most studies reported a decreased length of stay and reduction in hospital costs when clinical pathways were implemented.

Considerable variation in study design and settings prevented statistical pooling of results for length of stay and hospital costs. Generally poor reporting prevented the identification of characteristics common to successful clinical pathways. The authors concluded that clinical pathways are associated with reduced in-hospital complications.”

Kinsman L, Rotter T, James E, Snow P, Willis J. What is a clinical pathway? Development of a definition to inform the debate. BMC Med. 2010 May 27;8:31. 

“Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature.”

Clinical Pathways: sharing the lessons learnt
Presentations from June 2007 Seminar (Melbourne, Australia)


A web-site complementing a book : e-Pathways - computers and the patient's journey through care. Editors: Kathryn de Luc and Julian Todd, Radcliffe Medical Press, 2003. 

“This book describes the limitations of current approaches to care pathway development and contrasts them with the ambitious targets in the UK health service for computerised care pathways.  We think that a stronger and more coherent Community of Practice (CoP) is an essential first step towards, and foundation for, a more systematic approach to e-pathways.  In a sense, the capability of the CoP is a gauge for our organisational readiness to develop, maintain and implement computerised care pathways - which is a far harder problem than maintaining a CoP.”

AIHA Internet Resources Digest Forthcoming Topics [Provisional] 

  • Telemedecine
  • Open Access Initiatives
  • Authorship Skills
  • Web Design Tools
  • Patient Information Services

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