How does the implementation of a patient pathway-based intervention in the acute care of blunt thoracic injury impact on patient outcomes? A systematic review of the literature

Abstract

Highlights Patient pathways are complex interventions and have become central to systematic and effective trauma care in high income countries. Effective pathway evaluation processes are key to developing robust pathways with a demonstrable patient benefit. There are unclear benefits to using patient pathways in the management of blunt thoracic injury where empirical evaluation has been conducted. The importance of effective implementation methods is identified, there is a paucity of data indicating effective implementation clinically. More robust experimental research is required to understand the impact of patient pathways on patient outcomes and experience.

Building consensus on inpatient discharge pathway components in the management of blunt thoracic injuries: An e-Delphi study amongst an international professional expert panel

“…• Consensus was reached if 70% or more of the whole participant group rated an item 'High importance' (5)(6) or 'Moderate importance' (3)(4) and less than 15% rated an item 'low importance' (1-2). • Consensus was also reached if 70% or more of the participant group rated and item 'Low importance' (1-2)…”

“…Blunt thoracic injury (BTI) remains a common presentation to the emergency and trauma care setting and is associated with high levels of mortality and morbidity [ 1 , 2 ]. The development and evaluation of patient pathway-based interventions in the management of chest trauma is increasingly important in understanding how BTI is contemporaneously managed [3] has highlighted the lack of standardisation in practice by using pathway-based care, particularly in hospitals not designated as major trauma centres (MTC). One major challenge for non-MTCs are the availability of interventional components within the pathway (i.e.…”

“…One major challenge for non-MTCs are the availability of interventional components within the pathway (i.e. what might be available at one hospital, may not be readily available at another centre) indicating that a 'one fit' approach to pathway development is unlikely to be an effective model [3] . Rather, a 'toolkit' development framework with a 'how to build your own' approach is likely to effectively enable pathway building.…”

Implementation Evaluation of a Multidisciplinary Blunt Chest Injury Care Bundle (ChIP): Fidelity of Delivery

“…The ChIP intervention and implementation strategy are adaptable and were tailored for implementation at the sites for this study. In a recent systematic review of the blunt chest injury pathways, it was highlighted that pathways need to be highly adaptable to the patient and context [41]. The implementation plan included multi-modal implementation strategies, including educational sessions, a support video, clinical champions, audit and feedback, environmental changes and advertisements, which are common, accessible strategies that can be adapted and used at other sites.…”

Implementation Evaluation of a Multidisciplinary Blunt Chest Injury Care Bundle (ChIP): Fidelity of Delivery

“…The ChIP intervention and implementation plan were adaptable and were tailored for implementation at the sites for this study. In a recent systematic review of the blunt chest injury pathways, it was highlighted that pathways need to be highly adaptable to the patient and context [43]. The implementation plan included multi-modal hospital-wide implementation strategies, including educational sessions, a support video, clinical champions, audit and feedback, environmental changes and advertisements, which are common, accessible strategies that can be adapted and used at other sites.…”