Prevalence and quality of clinical pathways in <scp>S</scp>wedish intensive care units: a national survey

Bjurling-Sjöberg, Petronella; Jansson, Inger; Wadensten, Barbro; Engström, Gabriella; Pöder, Ulrika

doi:10.1111/jep.12078

Cited by 12 publications

(13 citation statements)

References 39 publications

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“…Local project groups should include persons who are able to appraise scientific literature [1]. The quality of CPs within ICUs [23], as well as in other settings in Sweden [35], varies and there are significant differences between the ICUs in the southern and northern regions regarding the use of CPs [23]. The present findings indicate a lack of national guidance and insufficient CP support at the local hospitals regarding the implementation.…”

Section: Discussionmentioning

confidence: 81%

“…A recent national survey reveals that many ICUs have plans for implementing CPs but CPs are actually in use at only 20% of the ICUs. Furthermore, the survey reveals that the quality of the CPs in use vary, with great differences regarding the content and extension as well as the degree to which the CPs are interprofessional, evidence‐based and renewed, which leads to concerns regarding the implementation process [23].…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting the implementation process of clinical pathways: a mixed method study within the context of Swedish intensive care

Bjurling-Sjöberg

Wadensten

Pöder

et al. 2015

Evaluation Clinical Practice

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Bottom-up initiatives, interprofessional project groups and small ICUs seem to enhance successful implementation of CPs while inadequate electronic health record systems, insufficient support and time constrains can be barriers. Support regarding the whole implementation process from centralized units at the local hospitals, as well as cooperation between ICUs and national guidance, has the potential to raise the quality of CPs and benefit the progress of CP implementation.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Factors affecting the implementation process of clinical pathways: a mixed method study within the context of Swedish intensive care

Bjurling-Sjöberg

Wadensten

Pöder

et al. 2015

Evaluation Clinical Practice

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“…The use of pathways in ICUs seems promising, as it can contribute to increased adherence to best-practice guidelines, streamlined care, a decreased mechanical ventilation time, and reduced complications [ 10 – 14 ]. As pathways are still rarely utilized in ICUs, further implementation has the potential to benefit both patients and healthcare providers [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Struggling for a feasible tool – the process of implementing a clinical pathway in intensive care: a grounded theory study

Bjurling-Sjöberg

Wadensten

Pöder

et al. 2018

BMC Health Serv Res

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BackgroundClinical pathways can enhance care quality, promote patient safety and optimize resource utilization. However, they are infrequently utilized in intensive care. This study aimed to explain the implementation process of a clinical pathway based on a bottom-up approach in an intensive care context.MethodsThe setting was an 11-bed general intensive care unit in Sweden. An action research project was conducted to implement a clinical pathway for patients on mechanical ventilation. The project was managed by a local interprofessional core group and was externally facilitated by two researchers. Grounded theory was used by the researchers to explain the implementation process. The sampling in the study was purposeful and theoretical and included registered nurses (n31), assistant nurses (n26), anesthesiologists (n11), a physiotherapist (n1), first- and second-line managers (n2), and health records from patients on mechanical ventilation (n136). Data were collected from 2011 to 2016 through questionnaires, repeated focus groups, individual interviews, logbooks/field notes and health records. Constant comparative analysis was conducted, including both qualitative data and descriptive statistics from the quantitative data.ResultsA conceptual model of the clinical pathway implementation process emerged, and a central phenomenon, which was conceptualized as ‘Struggling for a feasible tool,’ was the core category that linked all categories. The phenomenon evolved from the ‘Triggers’ (‘Perceiving suboptimal practice’ and ‘Receiving external inspiration and support’), pervaded the ‘Implementation process’ (‘Contextual circumstances,’ ‘Processual circumstances’ and ‘Negotiating to achieve progress’), and led to the process ‘Output’ (‘Varying utilization’ and ‘Improvements in understanding and practice’). The categories included both facilitating and impeding factors that made the implementation process tentative and prolonged but also educational.ConclusionsThe findings provide a novel understanding of a bottom-up implementation of a clinical pathway in an intensive care context. Despite resonating well with existing implementation frameworks/theories, the conceptual model further illuminates the complex interaction between different circumstances and negotiations and how this interplay has consequences for the implementation process and output. The findings advocate a bottom-up approach but also emphasize the need for strategic priority, interprofessional participation, skilled facilitators and further collaboration.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3629-1) contains supplementary material, which is available to authorized users.

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“…In relative terms, developed countries have more extensive implementation of clinical pathways (17). As an example, a Swedish study indicated that clinical pathways were in use at 20% of Swedish intensive care units (ICUs) and a total of 56 clinical pathways were reported within a range of fi elds and areas (18). A study of clinical pathways in 17 member states of the European Union found that that the United Kingdom had the highest estimated level of pathway use, with a level reaching almost 45% in 2004.…”

Section: Standardized Clinical Pathways In Chinamentioning

confidence: 99%

Standardized clinical pathways may potentially help to reduce the opacity of medical treatment in China – Reflections on the murder of a doctor in Wenling, Zhejiang

Lin

2013

Drug Discov Ther

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A doctor was murdered at Wenling First People's Hospital in Zhejiang, China on October 25, 2013. During the incident, a patient assaulted three doctors, resulting in the death of one of the doctors. This incident has led to a heated discussion about the unhealthy doctor-patient relationship in China. There are complex reasons for the strained doctor-patient relationship in China, but one aspect that helped lead to this situation is the opacity of medical treatment. Research has shown that implementation of clinical pathways reduces the variability of clinical practice and improves outcomes. Standardized clinical pathways can provide a standard for evaluation of the rationality of treatment and also suggest a recommended treatment, potentially reducing the opacity of medical treatment in China. However, the standardized clinical pathways that are currently in use in China still need to be improved. The implementation of clinical pathways needs to be increased, those pathways need to be formulated in detail, a supervisory body needs to be established, and the public needs to be better informed. These aspects should be studied further.

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Prevalence and quality of clinical pathways in Swedish intensive care units: a national survey

Cited by 12 publications

References 39 publications

Factors affecting the implementation process of clinical pathways: a mixed method study within the context of Swedish intensive care

Factors affecting the implementation process of clinical pathways: a mixed method study within the context of Swedish intensive care

Struggling for a feasible tool – the process of implementing a clinical pathway in intensive care: a grounded theory study

Standardized clinical pathways may potentially help to reduce the opacity of medical treatment in China – Reflections on the murder of a doctor in Wenling, Zhejiang

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