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. Analysis of the causes of variation further encourages adherence to the guidelines when they are clinically appropriate. Some clinicians believe that guidelines and pathways over-emphasise the clinical condition at the expense of individual patient care. In our experience, pathways provide patient-focused care, as they constantly monitor quality, and any deviation from the pathway identifies complications early.
Pathways also facilitate discharge planning as the median length of stay is defined.
In our clinical experience, pathways have been used successfully to coordinate care across the primary-secondary care interface. Chronic conditions such as asthma, obstructive pulmonary disease, diabetes and palliative care have been managed in this way. Some hospitals and general practices coordinate care using pathways for investigating and managing patients who present with conditions such as a breast lump or acute rectal bleeding. Pathways also have a part to play in clinical risk management. When the pathway is developed, current practice is reviewed and the most recent evidence incorporated into the pathway.