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Clinical Pathways to

enhance quality of care


Morris Gordon, Strategic quality lead
Simon Tucker, Consultant Emergency Medicine
Why do we need clinical pathways?

facilitating care in accordance with evidence based


best practice guidelines

reducing harm and insuring patient safety

appropriate treatment / appropriate team / appropriate location

Offering “Best in NHS” option

IT MAKES A DIFFERENCE
• For many patients – the first doctor assessing them is often a
“junior” doctor

• Pathway is a “tool” to insure


appropriate care is delivered
by those with less experience

• Pathway review and revision –


insures care plans offered are
up to date

• Patient safety :
– Fewer adverse events
– Improvements in morbidity & mortality

• Earlier referrals to allied health professionals

• Reduced length of stay / improvements in patient flow


• It works!!

• Sepsis – we all know and should


be able to recognise sepsis and
treat.

• However, major cause of mortality


– over 2000 deaths in the last 12
months in this trust were caused
by sepsis.

• Sepsis 6 – 6 core items for


diagnosis and management of
sepsis to be delivered 1 hour after
registration in and ED.

• If 100% compliance, the Relative


risk (odds of) death reduce by
45% - proven!!!!

If we translate this locally to the 2000 patients a year we identify


as septic in ED and consider the 1200 of them we currently don’t
deliver sepsis 6 to, there are potentially 100 completely
preventable deaths per annum
What would you include if
you were designing a care
pathway?
What to consider when designing a pathway?

• Best practice clinical guidelines :


– NICE
– BTS
– AQ

• Key performance indicators :


– Department of Health
– Strategic Health Authority
– NHS England
– College recommendations

• Untoward incidents / Lessons learned


How would you measure
compliance with the pathway you
have designed?
Measuring pathway compliance – the pathway checklist
The specialist pathway audit team are watching you

ALWAYS

So write it down

CLEARLY
How does the checklist influence quality of care?

• “mission critical” steps – aide memoire

• Daily review of compliance – failed measure reporting

• Failed measures forwarded to me

• Discussion with doctor involved where appropriate

• Maybe a reflective entry in doctor’s portfolio

• Remedial action for recurrent offenders


• Where are the pathway checklists kept on your ward?

• When reviewing a patient – be aware which pathways exist


and if your patient should be commenced on a pathway.
Final word

• Since introducing the pneumonia pathway with regard to


AQ standards of care – the compliance score for
pneumonia care improved from 60% to 90% - resulting in
both a national award for the team and an award at the
Celebrating Success award.
Recent review of AQ care standards shown that
compliance associated with better patient outcomes

• Since introducing the sepsis pathway, the SHMI for


patients coded for sepsis has reduced from 117 to 91 –
THAT IS MANY LESS PATIENTS DYING FOR
SOMETHING WE COULD AND NOW ARE DOING
BETTER!!!!