#Inform definition plus#

Our team of researchers faced this issue when devising the protocol for a Cochrane systematic review of the impact of clinical pathways in hospitals. A lack of consensus regarding research outcomes is not surprising given the lack of agreement regarding what defines a clinical pathway.

This lack of a uniformly accepted definition of what constitutes a clinical pathway impacts on capacity to empirically test the evidence base and compromises planning, resourcing, development and implementation of clinical pathways. These included (amongst others) care map, care pathway, critical pathway, integrated care pathway, protocol and guideline. In fact, a recent literature review identified 84 different terms that may mean a clinical pathway. In this era of evidence informed practice, it is therefore problematic that individual studies of the impact of clinical pathways are varied and contradictory and that there is still no standardised definition of what a 'clinical pathway' actually constitutes. This represents an enormous resource commitment both in the development of pathways, the training of staff, and in the ongoing implementation of pathways in the hospital setting. In 2003, it was reported that clinical pathways had been implemented in more than 80% of hospitals in the USA. The criteria used for the identification of relevant studies for this Cochrane Review can be used as a foundation for the development of a standardised, internationally accepted definition of a clinical pathway. The authors of the included studies referred to these interventions as 'clinical pathways', 'protocols', 'care model', 'care map', 'multidisciplinary care', evidence-based care' and 'guideline'. In all, 27 studies were included in the final review.

#Inform definition plus#

After pilot testing it was decided that if an intervention met the first criteria (a structured multidisciplinary plan of care) plus three out of the other four criteria then it was included as a clinical pathway for the purposes of this review. Previous literature and liaison with the European Pathways Association resulted in five criteria being used to define a clinical pathway: (1) the intervention was a structured multidisciplinary plan of care (2) the intervention was used to translate guidelines or evidence into local structures (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions' (4) the intervention had timeframes or criteria-based progression and (5) the intervention aimed to standardise care for a specific clinical problem, procedure or episode of healthcare in a specific population. We undertook a four-stage process aiming to develop criteria to define a clinical pathway: (1) identify publications exploring the definition of a clinical pathway (2) derive draft criteria (3) pilot test the criteria and (4) modify criteria to maximise agreement between review authors. 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. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes.

Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s.