Integrated clinical pathway management for medical quality improvement – based on a semiotically inspired systems architecture

Abstract

Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

Tracebook: A Dynamic Checklist Support System

“…Accordingly, there are computerized clinical pathway systems that can execute pre-scheduled care plans which are localized from clinical pathways [16] and computerized provider order entry (CPOE) systems that are used to give practitioners a package of best practices to a particular group of patients at the point of care [17].…”

Virtual Process Control Modelling in Organisational Semiotics: A Case of Higher Education Admission

“…Based on this perspective, organisational semiotics views organisations as information systems where agents create and use signs to perform purposeful activities [4] that are controlled by norms [11]. Business processes are conceived as behavioural activities controlled by norms as rules and regulations that determine which activities are permitted, mandated or prohibited [4,12] and which agents can or cannot perform such activities [13]. This study draws from three organisational semiotics models: organisational onion, organisational morphology, and norm analysis method.…”

Effect of Implementing Clinical Pathway Guidelines on Patients' Clinical Outcomes with Acute Coronary Syndrome

“…It support the management processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care by using a multidisciplinary team [14]. Clinical pathways aim to link evidence to practice and, therefore, optimize patient's clinical outcomes and maximize clinical efficiency of care [15].…”

“…The nurses review the orders and confirm their accomplishment. Other care team members such as the therapist, nutritionist, interns and clerks carry out all the orders in the pathway pertaining to them [14]. The clinical pathway for hospitalized patients with ACS is poorly established in Tanta University, although it is an integral part of total quality management.…”

“…The clinical pathway for hospitalized patients with ACS is poorly established in Tanta University, although it is an integral part of total quality management. The positive outcome of clinical pathway reported in the literature is decreased length of stay (LOS), improve hemodynamic parameters and prevent complications [14][15][16]. Therefore the aim of this study is to evaluate the effect of implementing clinical pathway guidelines on the clinical outcomes of patients with acute coronary syndrome.…”