EVIDENCE-BASED CARE MANAGEMENT TOOLS

    Judith Weinstein has proposed the interlinking of evidence-based care management tools, which may include:

    • Clinical practice guideline

    • Protocol

    • Medical directive

    • Routine Doctor's Orders

    • Clinical assessment sheet

    • Clinic flow sheets

    • Professional care path or map

    • Unit/program standards of care

    • Valid assessment tools

    • Key indicator and discharge criteria records

    • Patient version care path or map

    Care paths should be associated with building blocks that include standards of care (unit or program specific, e.g. when do you take vital signs postoperatively?), valid assessment tools (pain scale, dyspnea scale, etc), and carefully-gathered evidence. Care paths, to meet current definitions, must be multidisciplinary and patient-focused.

    Many hospitals have tried to solve multiple system problems through the care path development process and have included proposed solutions in the path content – doctors’ orders, documentation, etc. However, trying to solve system-wide problems through tools targeted at specific patient groups is ineffective. Instead, the presentation of the related information in a familiar but separate format ensures practitioners focus on important care content in the care paths.

    Physicians often prefer to look at key information in a path and at related guidelines in a Routine Doctor's Order Set, a familiar and comfortable format and process. Nurses who are experts prefer a list of the Key Indicators of Progress and Discharge Criteria; nurses who are less current in their knowledge look at the full path for a diagnosis. A guiding principle is to respect your experts but to keep the care path easy for them to review.

    Care paths should be designed in such a way that multidisciplinary health care groups use them to do something for patient care. The design should also result in "living tools", paths with continual cycles of feedback, evidence review, and tool updating. Multidisciplinary development groups that base their discussions on carefully-gathered and presented information, which focuses on patient needs and outcomes, are prepared for these challenges.


Page Created: August 19, 1999  by Program in Evidence-Based Care Cancer Care Ontario. Page Reviewed: June 4, 2002.     Page removed from CCO site    February 2003                   

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