lecture 9 - integrated care pathways nov 2010

7/30/2019 Lecture 9 - Integrated Care Pathways Nov 2010

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Learning objectivesDefinition of integrated clinical pathway,

incorporating national guidance and clinical

governance

How are they are constructed

The role of different healthcare professionalsand multidisciplinary issues

Professional accountability


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Background

In the 1980s, USA began to develop the integrated clinical

pathway tool to:

Focus on the patient rather than the system

Re-defined the delivery of care

To identify measurable outcomes.

To measure efficiency of the health care processes in order

to fulfil the requirements of the insurance industry.


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Background ........

In 1990 teams from the UK visited the USA toinvestigate the use of integrated clinical pathway

In 1991 the first integrated clinical pathway was

established in North West London

Integrated clinical pathways were clinician led with

patients and locally agreed best practice at their

heart.

In 2002 the electronic Pathways Database was

launched on National Health Library to enable free

sharing of integrated clinical pathway across UK


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Integrated Clinical Pathway


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Definition

An integrated care pathway is a multidisciplinary

outline of anticipated care, placed in an

appropriate timeframe, to help a patient with a

specific condition move progressively through a

clinical experience to positive outcomes.

www.evidence-based-medicine.co.uk


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Integrated Care Pathway:Describes the care process

within and across:

primary, secondary and tertiary care

Various health care settings

Health and social careIt also collects variations between

planned and actual care


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Aims of Integrated Clinical Pathways:

Facilitate introduction of guidelines & audit Improve multidisciplinary communication &

care planning

Improve quality of careReduce unwanted practice variation

Improve clinician-patient communication

Increase patients satisfaction

Identify research & development questions


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Integrated Care Pathway includes:

The right people

Doing the right things

In the right orderAt the right time

In the right place

With the right outcome

And most importantly focusing on the patients& their experiences


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Why were they developed

To reduce unnecessary variations in patient care Support partnerships in delivery of care

Empower patients and their carers.

To incorporate local and national guidelines into

everyday practice

Manage clinical risk

Meet the requirements of clinical governance


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Clinical Governance:A framework through which NHS

organisations are accountable for

continuously improving the quality of their

services and safeguarding high standards of

care by creating an environment in which

excellence in clinical care will f lourish.
http://www.wmin.ac.uk/sih/page-515http://www.wmin.ac.uk/sih/page-515http://www.wmin.ac.uk/sih/page-515http://www.wmin.ac.uk/sih/page-515http://www.wmin.ac.uk/sih/page-515


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Integrated Care Pathways contain:Multi-disciplinary, multi-agency, clinical and

administrative activitiesEvidence based, locally agreed, best practice

Local and national standardsVariance trackingTests, charts, assessments, diagrams, letters,

forms, information leaflets, satisfactionquestionnaires etcScales for measurement of

clinical effectiveness
http://images.google.co.uk/imgres?imgurl=http://www.acpinternist.org/archives/2008/04/nine_lg.jpg&imgrefurl=http://www.acpinternist.org/archives/2008/04/nine.htm&usg=__MFLoL4ojNlxlj8qB_K6f74okco8=&h=288&w=275&sz=31&hl=en&start=164&tbnid=beEVFnRlVTVYpM:&tbnh=115&tbnw=110&prev=/images?q=improve+medication&gbv=2&ndsp=20&hl=en&sa=N&start=160


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Requirements for successful ICPs?

Select an important area of practice Gather support for the project from relevant people

Form a multidisciplinary group

Identify established guidelines e.g. NICE, NPSA Review practice, both current and past

Involve local staff from all disciplines

Identify service improvements and set goals

Prepare paperwork, Educate staff, pilot

Analyse & discuss variances regularly


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The role of the ICP Facilitator

leadership and marketing

project management including:

planning and evaluation

implementation skills including trouble-shooting communication, chasing, motivating, negotiating

facilitation especially process mapping & ICP

writing training, mentoring, support

feedback mechanisms

delivery of the goods
http://images.google.co.uk/imgres?imgurl=http://www.naset.org/uploads/pics/Working_together.gif&imgrefurl=http://www.naset.org/2435.0.html&usg=__w1rL2vrzUOuZ0LiwWeplpp2Tst8=&h=348&w=450&sz=63&hl=en&start=18&tbnid=0e5-FKQgIfErKM:&tbnh=98&tbnw=127&prev=/images?q=working+together&gbv=2&hl=en&sa=G


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Skills required for ICP facilitator:

Facilitation & negotiation skills

Project management

Managing diverse and complex teams

Conflict management

Assertiveness skills

Communication and public relations


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Designing ICP Documentation

It should be quick and easy to complete Intuitive

Accessible

Meaningful

Part of the routine of clinical/administrativerecord keeping

Clearly linked with the relevant activity by aunique identifier


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Other terms used for ICP

Anticipated Recovery Pathways (ARPs)

Multidisciplinary Pathways of Care (MPCs)

Care Protocols

Critical Care Pathways Pathways of Care

Care Packages

Collaborative Care Pathways Care Profiles


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What are the characteristics of an ICP?

Systematic action for consistent best practice andcontinuous improvements in patient care withattention to the patient experience

Patient centred - built into packages of care for

identified groupings Provides continuous feedback via variance tracking

and analysisMultidisciplinary

Maps and models clinical and non-clinical careprocesses Incorporates guidelines and protocols includes standards and outcomes
http://images.google.co.uk/imgres?imgurl=http://www.leadership.prn.bc.ca/wp-content/working_together_teamwork_puzzle_concept.jpg&imgrefurl=http://www.leadership.prn.bc.ca/?m=200903&usg=__vAPC2ER8FIXE2BbCsL4qpNlUAdY=&h=3000&w=3000&sz=1948&hl=en&start=8&tbnid=mIX5NpNsF7TkaM:&tbnh=150&tbnw=150&prev=/images?q=working+together&gbv=2&hl=en&sa=G


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Example of using ICP to

improve services in

diabetes care:

Map the current patientcare pathway

Design a patient

focused services Steps from current to optimal services

Plan for resource implications


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Diabetes Care Level of provision of patients education varies

considerably

Patients are mainly seen in primary care

GPslevel of knowledge and competency in

managing diabetes varies significantly

Complicated patients are sent to diabetic clinics inhospital to be seen by consultants and diabetesspecialist nurses

Diabetes checks including eyes and feet may notbe performed regularly


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Diabetes Clinics in secondary

care (Consultants, DSNs)

GPs at

Beacon

practices

All Type II,

most Type I

and some

complicated

patients

GPs with

interest in

diabetes

All Type II,

No Type I

GPs with

no diabetic

servicesMost Type II

Referrals


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Interim Solution / Outreach Clinic

Specialist Nurse

Diabetes clinics

GP / Practice Nurse

The GPs & Practice nurses get training

Patients who are/ can not be seen

by their GPs come to this clinic

(Ist One Stop Shop is designated

to house bounds)

Trained GPs can treat

Non complicated

diabetics patients

Retinopathy Screening Chiropodist

Trained GPs can

refer complicated

diabetic patients to clinic

DieticiansEducated patient

Transport


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1. Look at the SLIPS (Southwark and

Lambeth Integrated Care Pathway forOlder People with Falls) and complete

the gaps in the following forms:

a: Client information formb: General Falls assessment (Drug History)

2. Look at theRheumatoid arthritis NICEguideline and identify pharmacist role in this ICP.
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lecture 9 - integrated care pathways nov 2010

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