Clinical care pathway strenghens interprofessional collaboration and quality of health service: a literature review

Asmirajanti, Mira; Hamid, Achir Yani S.; Hariyati, Tutik Sri

doi:10.1016/s1130-8621(18)30076-7

Cited by 26 publications

(21 citation statements)

References 24 publications

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“…A comprehensive review highlighted its paramount indings that successful CP implementation was predicted by some determinants including the novelty of evidence supporting CP, effective dissemination approaches, adequate support from the organization, continuous collaboration and communication among healthcare professionals, availability of regular audit and monitoring of CP implementation (Asmirajanti et al, 2018).…”

Section: Resultsmentioning

confidence: 99%

Effects of Clinical Pathway Implementation in Management of Pediatric Inpatients with Pneumonia: A Cross-Sectional Study in Indonesia

Lizikri¹,

Arozal²,

Ramadaniati³

2020

ijrps

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Pneumonia is the leading cause of morbidity and mortality in children worldwide. Antibiotics are the mainstay treatment for bacterial pneumonia so their use should be clearly mentioned in the pneumonia clinical pathway (CP). This study aimed to evaluate the effectiveness of pneumonia CP in pediatrics. A cross-sectional observational study was conducted in a private hospital in Indonesia. The inclusion criteria were pediatric patients admitted with pneumonia in the period of January-December 2017 (pre-CP period) and January-December 2018 (post-CP) and receiving antibiotics. The effectiveness of CP was evaluated according to four parameters: length of stay, clinical outcomes, quality (Gyssens antibiogram) and quantity of antibiotics. A total of 121 eligible patients’ medical records were analyzed (60 before and 61 after CP implementation). Second and third generation cephalosporins (42.1%) predominated the use of antibiotics pre-CP period, whilst aminoglycosides (59.6%) constituted more than half of antibiotic use in post-CP group. More than half of the patients stayed in the hospital not more than 3 days pre-CP period vs 31.1% post-CP period. Nearly all patients had good clinical outcomes during hospitalization between both periods. The proportion of quality of antibiotics was less than 5% either before or after CP implementation. The quantity of antibiotics post-CP (408.42 defined daily dose/DDD per 100 patient days) was almost two times of pre-CP period (222.42 DDD per 100 patient days). In conclusion, implementation of CP could not achieve the targeted goals to reduce the length of hospitalization and improve the antibiotic use. No discernible difference was observed in clinical outcomes before and after CP implementation.

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Section: Resultsmentioning

confidence: 99%

Effects of Clinical Pathway Implementation in Management of Pediatric Inpatients with Pneumonia: A Cross-Sectional Study in Indonesia

Lizikri¹,

Arozal²,

Ramadaniati³

2020

ijrps

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“…3,4 There is a considerable amount of evidence that implementation of CP can reduce both the length of stay in hospital and cost of treatment, without undesirable outcomes and postoperative complications. [5][6][7][8][9] However, these studies have never been performed in health system of the Republic of Srpska.…”

Section: Study Periodmentioning

confidence: 99%

The role of clinical pathways on healthcare quality improvement in hospitals for patient undergoing total hip replacement

Štrbac¹,

Rakić²,

Vujić-Aleksić³

et al. 2020

Scripta Medica

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Background: Clinical pathways are important tools to achieve better quality of care and to reduce the costs for healthcare system. The total hip replacement (THR) is among the most expensive procedures in health system and the number of these operations has greatly increased in the past decade in the Republic of Srpska. Aim: The aim of the present study was to determine how the implementation of a clinical pathway for THR can influence the length of stay and postoperative complications in hospitals in the Republic of Srpska. Methods: This prospective and comparative study was performed on 2,485 patients who underwent the THR over a 3-year-period in 2012 (prior to the introduction of the clinical pathways, baseline), in 2013 (first evaluation period) and in 2014 (second evaluation period), one and two years after its implementation, respectively. The study was conducted in 10 hospitals in the Republic of Srpska, where the effects of the clinical pathways on length of stay and postoperative complications after THR were measured. Results: The introduction of THR clinical pathways significantly decreased the length of stay in hospital from 14.53 ± 7.03 days measured at baseline, to 12.79 ± 4.81 days and 11.19 ± 4.11 days at first and second evaluation period, respectively. At the same time, the number of early postoperative complications such as death and venous thromboembolism significantly decreased in both groups, while the number of dislocations, as parameter of late complications, decreased just after the second evaluation period. For all other complications, such as revision procedures, infections and periprosthetic fracture, there were no statistical differences after the implementation of clinical pathways. Conclusion: The introduction of clinical pathways was successful in reducing the length of stay in hospitals as well as the postoperative complications after THR.

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“…When assigned to a specific patient, the pathway should be adapted to the needs and preferences of the individual person (Vanhaecht et al, 2012). Clinical pathways are proven to enhance care quality and patient safety and optimize patient outcomes and resource utilization (Asmirajanti et al, 2018;Seys et al, 2017). However, as with all interventions, the effect of a pathway is probably related to the process of implementation, which is minimally reported in current pathway publications.…”

Section: Introductionmentioning

confidence: 99%

Action research improved general prerequisites for evidence-based practice

Bjurling-Sjöberg

Pöder

Jansson

et al. 2021

Heliyon

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The present study was part of an action research project that was performed to implement a clinical pathway for patients on mechanical ventilation and simultaneously explore the implementation process in a Swedish intensive care unit. The aim of this questionnaire study was to evaluate whether an action research methodology could affect the general prerequisites for evidence-based practice (EBP). Informed by the Promoting Action on Research Implementation in Health Services (PARIHS) framework, the study included registered nurses, assistant nurses and anesthesiologists in the unit at start of the project (n ¼ 50) and at follow-up (n ¼ 44). Data was collected with the Evaluation Before Implementation Questionnaire and the Attitudes towards Guidelines Scale.The results revealed that the general prerequisites for EBP in the setting improved. Compared to baseline measurements, the staff at follow-up conversed significantly more about the importance of the patients' experiences, research utilization, context and facilitation, while changes with respect to clinical experiences were not significant. The attitudes towards guidelines were perceived as positive at baseline as well as at follow-up and did not significantly change.Longer professional experience was associated with a slightly lower probability of perceiving that the importance of research utilization was discussed and reflected upon, while belonging to a profession with longer education was associated with a higher probability of this perception. Compared to registered nurses and assistant nurses, the anesthesiologists perceived, to a greater extent, that the importance of clinical experience was discussed and reflected upon in the setting, while there was no significant association with the length of professional experience and/or specific professions regarding the other components.In conclusion, using action research to implement a clinical pathway methodology seems to set in motion various mechanisms that improve some but not all prerequisites that, according to the PARIHS framework, are advantageous for EBP.

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Clinical care pathway strenghens interprofessional collaboration and quality of health service: a literature review

Cited by 26 publications

References 24 publications

Effects of Clinical Pathway Implementation in Management of Pediatric Inpatients with Pneumonia: A Cross-Sectional Study in Indonesia

Effects of Clinical Pathway Implementation in Management of Pediatric Inpatients with Pneumonia: A Cross-Sectional Study in Indonesia

The role of clinical pathways on healthcare quality improvement in hospitals for patient undergoing total hip replacement

Action research improved general prerequisites for evidence-based practice

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