Integrated Clinical Pathways: Communication and Participation in a Multidisciplinary Team

BACKGROUND: An integrated clinical pathway (ICP) is a key method for structuring or planning processes of care, enabling the modernization of health-care delivery and coordination of multiple roles, forming a complete, patient-centered multidisciplinary health-care team and establishing the sequence of activities, promoting individual and team communication, collaboration, networking, and transparency, and reducing the cost of care. AIM: As there is a research gap in the area of communication among members of a multidisciplinary team for the treatment of patients through an ICP, the aim of this study was to determine the impact of communication of a member of a multidisciplinary team on the active participation of an individual in this multidisciplinary team. METHODS: A cross-sectional study of three ICPs, forchronic kidney disease, stroke, and total hip arthroplasty was conducted in a typical Slovenian general hospital. RESULTS: The results show that in the analyzed hospital, two of the three clinical pathways are not yet fully integrated. CONCLUSION: There is a weak influence of staff communication within a multidisciplinary team on an individual’s participation in this multidisciplinary team, indicating the need for various activities to actually implement clinical pathway “integration,” and promote better communication within teams to strengthen participation in multidisciplinary patient care pathways.

Development of a Model Care Pathway for Myasthenia Gravis

Myasthenia Gravis (MG) is a chronic, life-lasting condition that requires high coordination among different professionals and disciplines. The diagnosis of MG is often delayed and sometimes misdiagnosed. The goal of the care pathway (CP) is to add value to healthcare reducing unnecessary variations. The quality of the care received by patients affected with MG could benefit from the use of CP. We conducted a study aimed to define an inclusive, comprehensive, and multidisciplinary CP for the diagnosis, treatment, and care of MG. The development of the model CP, key interventions, and process indicators is based on the literature review and 85 international MG experts were involved in their evaluation, expressing a judgment of relevance through the Delphi study. 60 activities are included in the model CP and evaluated by the MG experts were valid and feasible. The 60 activities were then translated into 14 key interventions and 24 process indicators. We believe that the developed model CP will help for MG patients to have a timely diagnosis and high-quality, accessible, and cost-effective treatments and care. We also believe that the development of model CPs for other rare diseases is feasible and could aid in the integration of evidence-based knowledge into clinical practice.

Care pathways for organ donation after brain death: guidance from available literature?

AIMS

A discussion of the literature concerning the impact of care pathways in the complex and by definition multidisciplinary process of organ donation following brain death.

BACKGROUND

Enhancing the quality and safety of organs for transplantation has become a central concern for governmental and professional organizations. At the local hospital level, a donor coordinator can use a range of interventions to improve the donation and procurement process. Care pathways have been proven to represent an effective intervention in several settings for optimizing processes and outcomes.

DESIGN

A discussion paper.

DATA SOURCES

A systematic review of the Medline, CINAHL, EMBASE and The Cochrane Library databases was conducted for articles published until June 2015, using the keywords donation after brain death and care pathways. Each paper was reviewed to investigate the effects of existing care pathways for donation after brain death. An additional search for unpublished information was conducted.

DISCUSSION

Although literature supports care pathways as an effective intervention in several settings, few studies have explored its use and effectiveness for complex care processes such as donation after brain death.

IMPLICATIONS FOR NURSING

Nurses should be aware of their role in the donation process. Care pathways have the potential to support them, but their effectiveness has been insufficiently explored.

CONCLUSION

Further research should focus on the development and standardization of the clinical content of a care pathway for donation after brain death and the identification of quality indicators. These should be used in a prospective effectiveness assessment of the proposed pathway.