[Ideal Model of Neurosurgical Clinical Pathways:From a Basic Inpatient Pathway and Add-on Pathways to a Multilayered...

In acute neurosurgical care, clinical courses often deviate from expected pathways, and patient safety, reassurance, and comfort may be insufficiently ensured after conventional pathways end.

To present an ideal, implementable model of neurosurgical clinical pathways in an electronic medical record (EMR) environment.

Based on real-world implementation in 2013 at a regional core hospital, the framework was organized into four components: (1) a basic inpatient pathway applied to all patients; (2) physician-applied add-on pathways covering disease-, condition-, and procedure-specific elements; (3) outcome-oriented documentation using the Outcome-Task-Assessment framework; and (4) a multilayered system enabling stepwise additions without creating duplicate tasks.

Separating basic inpatient and add-on pathways improved feasibility in emergency settings and reduced physician application time from 16 min to 2 min. Additionally, an add-on pathway application rate of approximately 95% was maintained by emphasizing generalizability while developing dedicated add-ons for representative conditions.

In an EMR setting, a multilayered pathway model can sustain minimum standards of care for all patients while allowing stepwise, patient-specific additions, thereby balancing standardization and individualized management without compromising usability in acute care.