Computerized clinical pathways (care plans): piloting a strategy to enhance quality patient care

Having paper and electronic documentation can interfere with staff communication and workflow. In this 950-bed multicampus acute healthcare network in the southeastern United States, paper pathways did not clearly demonstrate multidisciplinary documentation and involvement in the plan of care. The majority of documentation was computerized, but clinical pathways remained in the paper chart. Limited literature findings, incomplete pathway documentation, and nurse dissatisfaction with cumbersome documentation processes created the impetus for this practice change.

To provide a sound basis for transitioning the pathways into the electronic medical record, a pilot was conducted on 1 medical-surgical department using 1 computerized pathway. Outcomes were measured utilizing pathway documentation audits and staff perception surveys. PROJECT OUTCOMES: Pilot results revealed improvements in pathway documentation and staff satisfaction with use of the computerized pathway. There was a 69% increase in the documentation of barriers to patient progression/utilization of the problem list, 10% increase in documentation of patient medication teaching, and 31% increase in documentation by ancillary staff using the computerized pathway. According to the survey results, staff perceived that the computerized pathway was a more useful tool in (1) prompting them to educate the patient (36% increase compared with paper); (2) communicating pertinent patient information during shift report (34% increase compared with paper); and (3) documenting barriers to patient progression (30% increase in comparison to paper). Based on these results, approval was obtained from health network administrators to move forward with system-wide implementation.

In order for clinical pathways to be effective, patient-centered communication tools, they must be easily accessible, be utilized by all health team members, and complement day-to-day workflow. Piloting innovative practice changes helps to garnish buy-in and support from all levels of the healthcare team.

Automation provides a first step to easier accessibility and linkage of pathways to other pertinent information and multidisciplinary patient care processes. Computerized pathways may be an impetus for healthcare providers to view automation as a key step to improving multidisciplinary care delivery and patient care quality.