Introduction of Clinical Pathways in Orthopedic Surgical Care: The Experience of the Hospital for Special Surgery

Abstract

Clinical pathways are structured multidisciplinary care plans which address specific clinical scenarios which help to standardize and coordinate care. Clinical pathways are evidence based incorporating proven best practice but ideally can be adopted to any given hospital environment and culture. Clinical pathways aim to optimize the quality and efficiency of care. These care plans must address pre-hospital preparation, the in-hospital care, and the post-hospital discharge. The patient experience can be optimized leading to improved overall patient satisfaction. The care plan must be focused on the patient experience primarily. Managing patient expectations through pre-hospitalization education and counseling is a key element of success. Adoption of clinical pathways demands physician championship which is best achieved by recording and providing feedback on outcomes following adoption of the new care plans. In high-volume clinical settings adoption of standardized care plans known as clinical pathways can improve patient outcomes and safety and provide for more efficient and satisfying care. The creation of clinical pathways should be based multidisciplinary involving all members of the healthcare team. Each hospital should design clinical pathways based on their unique environment and should be specific to patients undergoing particular medical procedures. Through rigorous planning and following of procedures in clinical pathways, hospitals are able to decrease the incidence of complications and length of stay, improve budget planning, and much more. Following implementation all clinical pathways must be routinely monitored for success and for modification to ensure that best clinical practices are represented and that continuous process improvement is assured.