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Published on: January 20, 2019
Do clinical pathways really improve clinical performance in mental health settings?
Brett Emmerson1, Aaron Frost, Lisa Fawcett
1RBWH Mental Health, Discipline of Psychiatry, University of Queensland, Brisbane, QLD, Australia. brett_emmerson@health.qld.gov.au
Summary
Clinical pathways for mental health failed to improve outcomes in an acute inpatient setting. The study suggests that the complexity of mental disorders makes these pathways unsuitable for mental healthcare.
Area of Science:
- Mental Health Services Research
- Clinical Pathway Implementation
- Healthcare Management
Background:
- Royal Brisbane and Women's Hospital (RBWH) Mental Health initiated trials of clinical pathways for psychosis and depression.
- Initial trials occurred between 2001 and 2003, aiming to enhance clinical and financial metrics.
- Strong senior management support, resource allocation, and staff backing were evident.
Purpose of the Study:
- To evaluate the effectiveness of an acute inpatient clinical pathway in mental health.
- To assess improvements in clinical and financial parameters following pathway implementation.
Main Methods:
- Development and trial of two initial clinical pathways (psychosis, depression) from 2001-2003.
- Reworking and combining pathways into a single acute inpatient pathway after a 6-month trial.
- Monitoring clinical and financial parameters of the acute inpatient pathway from October 2003 to 2004.
Main Results:
- The acute inpatient clinical pathway was trialled for a 12-month period.
- No significant improvements were observed in clinical or financial parameters during the trial.
- The pathway's use was discontinued due to lack of demonstrated benefits.
Conclusions:
- Clinical pathways did not yield improvements in clinical or financial outcomes for acute inpatient mental health care.
- The inherent complexity, individuality, and variability of mental disorders challenge the utility of standardized clinical pathways in mental health settings.
- Further research may be needed to explore alternative models for mental healthcare delivery.
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