1. Clinical Pathways to enhance quality of care
Morris Gordon, Strategic quality lead
Simon Tucker, Consultant Emergency Medicine

2. 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

3. 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

4. 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

5. What would you include if you were designing a care pathway?

6. 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

7. How would you measure compliance with the pathway you have designed?

8. Measuring pathway compliance – the pathway checklist

9. The specialist pathway audit team are watching you ALWAYS So write it down CLEARLY

10. 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

11. 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.

12. 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!!!!