What is a Care Pathway?

Ali El-GhorrImplementation Advisor

Overview of presentation Overview of presentation

Different types of care pathways

How to develop an ICP for BPD

Example mental health ICP

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PathwayAlgorithmReferral PathwayProtocolCare PathwayPatient PathwayTriage PathwayService PathwayGuidelineCritical PathwayIntegrated Care Pathway

What’s in a name?What’s in a name?

Algorithm

Care Pathway

Integrated Care Pathway

Algorithm Algorithm

Decision aid

One page summary

Based on evidence

Layed out as a decision tree

Usually used by 1 professional in the care of 1 individual

Clinical judgement still important

Example:

Alcohol Screening and Brief Interventions Algorithm

Care Pathway

Care Pathway Care Pathway

Diagrammatic representation of a journey of care

Multidisciplinary

High level map of care

Based on evidence and good practice

Includes all main referral routes & referral criteria

Describes who is responsible for what

Includes main comorbidities and complications

Applies to ~80% cases

What is an Integrated Care Pathway (ICP)?

Integrated Care Pathway Integrated Care Pathway

A system of care that allows the A system of care that allows the

comparison of planned care comparison of planned care

with care actually givenwith care actually given

Integrated Care PathwaysIntegrated Care Pathways

Focus on the service user

Part of the care record

Map out the expected care (multidisciplinary/multi-agency)

Describe how care should be structured and co-ordinated

Set standards along the care journey based on the evidence &

best practice

Facilitate the monitoring of these standards through VARIANCE

tracking

Mental HealthMental Health

ICPs ICPs

Policy Context Policy Context

Delivering for Mental Health (Dec 2006):

National policy to improve

mental health services

through development and

implementation of

Integrated Care Pathways

Person-centred

Safe

Effective

The Healthcare Quality The Healthcare Quality Strategy for NHSScotlandStrategy for NHSScotland

QIS standards

ICP StandardsICP Standards

How do you develop an ICP for BPD?

Process StandardsProcess Standards

Stakeholder involvement

Process mapping

Delivering togetherDelivering together

Psychologists

Consultants

Nurses

AHPsSocial Work

Improvement Support Staff Service users and carers

Local Teams

Voluntary sector Managers

GPs

Involving Primary Care

Possible incentivesPossible incentives

- ICP links to Quality Outcomes Framework: Mental health register

Physical health checksDementia reviewDepression screeningDepression assessment using validated tool

- ICPs linked to psychological therapies HEAT target

High level

Increasing level of detail

Process Mapping

Opportunity for Redesign

Content

Service user at the centre of care planning

Comprehensive assessment

Risk management

A service user rated measure of needs (eg Avon)

Targeted inpatient admission

Measure outcome

There is a record of medication for BPD

Example:

NHS Tayside mental health admission and discharge ICP

Admission & Discharge ICPAdmission & Discharge ICP

Implementation

Local implementation

Part of local strategy

Identify local champions / leads

Embed ICP work within Care Governance

Conduct awareness raising & education

Repeat education programme

Audit, review & provide feedback

Support availableSupport available

National ICP toolkit (www.icptoolkit.org)

Network of National ICP Co-ordinators & ICP Team

BPD Network

Co-ordinated approach (Health Directorates, NHS

Education Scotland, Social Work, Care

Commission and others)

IncentivesIncentives

Quality strategy (person centred, safe, effective)

Patient safety in mental health

HEAT targets in mental health

Quality Outcomes Framework

Partnership working (Social Work & Voluntary Sector

ICP accreditation

ConclusionsConclusions

Different types of care pathways

ICPs are a system of care

ICPs are a tool for service redesign and continuous quality improvement

Focus on service user and meeting their needs

Support and help is available

www.icptoolkit.org

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Welcome to the Scottish Personality Disorder Network ConferenceThursday 17th March 2011