Common Issues in Organization-Wide Pathway Systems

Common issues in the development of organization wide pathway system include basic questions such as “what is this and can it fit comfortably into my practice” to more complex issues in dealing with expected variability in patient progress, while still tracking and managing unacceptable variability. The following information about these issues is extracted from pages originally developed for Cancer Care Ontario’s Program in Evidence-based Care (CCO PEBC), and posted on their website from 1999 to 2003. LINK

Information about Pathways for the Tool Development Team

One of the pages originally posted on the CCO PEBC site was focused on information for physicians to help in understanding what paths are and how they might be used.

Another concern for members of the care team is the patient group that may have a real range in time needed for clinical progress .

Some Ways to Show Acceptable Variability within Paths & Related Tools

In Ontario, it is common practice to include a statement on Paths to indicate that there is acceptable variability in practice within each path.
  
Lakeridge Health Oshawa used the phrase "This is a pro-active planning tool to avoid delays in treatment and discharge. THESE ARE NOT ORDERS, only a guide to usual orders." This phrase has also used by Niagara Health System, and by the Grey-Bruce Network
 
Related documents such as Routine Physician Order Sets, or Key Indicator & Discharge Criteria Record may include instructions like "Please Delete and/or add indicators according to PHYSICIAN TREATMENT PLAN".  Patient Version Paths often have a phrase such as "This is a guide to what may happen to you in hospital. All patients are treated individually".
  
Other ways of indicating acceptable variability within pathways include using phases of care for patient groups. A Pathway for Heart Failure uses four phase to guide the timeline - Admission Day 0, Day/Phase 1, Day 2-3/Phase 2, Day 3-5/Phase 3 (target discharge)

For more information contact:

Judith Weinstein
The Brondesbury Group
144 Front Street West, Suite 650
Toronto ON M5J 1G2
Phone: 416-585-2414 ; 1-800-530-7195
judith.weinstein@brondesbury.com