What is an Integrated Care Pathway?

Physically it is a structured chronological, multidisciplinary clinical record, developed by local development groups, to suit a local situation. The formal definition is:

“An Integrated Care Pathway is a tool,

  • which is locally agreed,
  • multidisciplinary,
  • based on guidelines and evidence where available,
  • for a specific patient/client group,
  • forming all or part of the clinical record,
  • documenting the care given,
  • facilitating the evaluation of outcomes for continuous quality improvement.”

Sue Overill, Journal of Integrated Care (1998), 2, 93-98

What does it look like?

The structure is decided by the development group, but could consist of:

  • A front page (paper or electronic) with patient identifiers, criteria, source etc., section for initials/signatures
  • Initial ‘Use of this ICP’ information/protocols
  • Chronological plan of care/treatment by phases of care – daily (or more or less often), or by criteria (move to phase 2 once the following criteria are met)
  • Details of guidelines/instructions, etc.
  • Variance tracking section (either separate sheet or incorporated into each page)

What’s different about it?

  • It is integrated multi-professional documentation, (possibly sitting close to the patient) based on the patient’s journey.
  • The Variance sheet allows staf to note when the patient does not follow the usual pattern for that episode of care/procedure/condition.  The process involves:
    • Noting a Variance has occurred at the appropriate place on the ICP and then giving greater details on the Variance sheet/section;
    • Reviewing these Variances at regular intervals to ensure the ICP still represents what should happen.  Constant Variances for a particular task/activity would result in the documentation being changed to reflect actual practice, unless the evidence base says otherwise.  In the case of the latter the Variances will have identified required changes to practice, training issues, etc.  which will need to be addressed.
  • The incorporation of an Initial/Signature sheet saves huge amounts of signing and is a medico-legal issue to ensure that each entry can be traced to a named individual.

Who is responsible for it?

  • A local multi-professional group has researched the evidence base.
  • This group has a local co-ordinator (or two), as well as a lead clinician (or two).
  • The group is also responsible for evaluating its implementation.  Issues for this review include:
    • compliance with the documentation;
    • information coming from the Variances noted;
    • achievement of standards/outcomes monitored via the documentation;
    • staff comments/problems with the documentation.

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