We would all agree that having evidence based
integrated care pathways are certainly an essential
instrument in attempting to deliver Clinical
Governance. The problem, as a number of people on the
list have commented is co-ordination, co-operation,
implementation and maintaining the standards once the
initial flush of enthusiasm has worn off.
I would disagree with Tim a little, new co-ordination
strategies and monies are not what is needed. The
information is already out there.....and as Cochrane
and a number of other Evidence based organisations are
finding....new information surfaces too rapidly to
keep up!
So.....how to progress the debate?
1) As mentioned earlier, the information and variants
of care pathways are already there....what is needed
is energy, enthusiasm, communication and the ability
to herd an often disparate bunch of stakeholders.
2) Each institution will have local needs, resource
issues and political climates which will require
tailoring of the care pathway. The process of
evaluating aand presenting the evidence is essential
to getting people on board. Concentrating energies on
these issues and massaging a few egos along the way
will probably lead to a successful care pathway.
3)The care pathway that is devised should clearly also
list a minimum of the following:
a) the evidence that it is based upon.
b) the local resources available for implementing and
maintaining Quality Assurance.
c) The outcomes to be measured (explicitly)
d) Relationship to the government National Service
Framework and High Level Performance Indicators
e) strategies for QA
A database of care pathways is certainly useful to
record people's experiences and could probably be
achieved at little expense. Resources required would
be 30-40 minutes of Dr Ryan's valuable time (sorry
John...to volunteer you) in adding a facility onto the
BAEM website with some QA filters.....'biggest bang
for your buck'. Alternatively just use this group and
the threads created.
regards
Taj
=====
Dr Taj Hassan
Consultant in A&E Medicine
Dept of A&E Medicine
Leeds General Infirmary
Leeds LS1 3EX, UK
Tel : (0113) 292 6470 Fax : (0113) 292 2810
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