The article by Dowsey et al 1 in this issue of the Journal is significant. This is the first report in the Australian medical literature that documents the impact of clinical pathways in a tertiary care setting, and is also one of the first randomised trials to show that the use of pathways can improve clinical outcomes. A clinical pathway is a tool that sets locally agreed clinical standards, based on the best available evidence, for managing specific groups of patients. The pathway forms part or all of the patient's record and allows the care given by members of the multidisciplinary team, together with the progress and outcome, to be documented. Variations from the pathway are recorded, and analysis allows a continuous evaluation of the effectiveness of clinical practice.
Information thus obtained is used to revise the pathway to improve the quality of patient care.
Pathways were introduced into the United Kingdom in the early 1990s and are used for treating patients with a wide variety of clinical conditions in primary, secondary and tertiary care. They may also include a specific procedure, such as renal biopsy, or encourage the use of therapeutic guidelines, such as postoperative analgesia. Standardisation of care has been shown to improve outcomes 4 and poor quality healthcare is often associated with unjustifiable variation in clinical practice. 5 Dowsey and colleagues 1 have shown that when they introduced pathways for hip and knee joint arthroplasty better patient outcomes were achieved. 7,8 Pathways facilitate the use of guidelines by the multidisciplinary team, as they are locally agreed and are available in the patient's record when decisions are being made.