Integrated Care Pathways (ICP) gained prominence within the British health care system in the 1990s. However, the original concept developed within the USA as a model to assess quality in engineering by defining processes and auditing variances and outcomes (Overill, 2003). Karen Zander, a nurse educator from Massachusetts, is credited with recognising the salience of such principles for the effective and consistent delivery of healthcare in the USA in the 1980s. Clinicians saw the need to redefine care delivery and identify outcomes in a measurable way as a means of demonstrating high quality yet cost effective care (Overill, 2003).

Developing these pathways requires consensus by multi-disciplinary teams to agree a comprehensive and holistic process for a specific episode of care which is anchored in available evidence based practice. The function of care pathways is to map the required care for a specific clinical condition and attempt to describe all of the tasks that should be undertaken together with the timing and sequence of those tasks. The resultant multi-disciplinary documentation, that generally replaces all existing documentation, then acts as a template which guides practitioners to deliver appropriate care and enables the recording of outcomes. 

However, use of an ICP is in no way meant to replace clinical judgment and decision making. Whenever clinicians feel that the prescribed course of action is not the most appropriate one for a given individual, or it is not possible to undertake a particular action in given circumstance, it is perfectly acceptable to deviate from the ICP by recording the variation in practice ('variance') on the documentation. A clear indication of the rationale underpinning the decision or reason for deviation is then also documented, along with subsequent actions taken. The combination of the provision of guidance and the ongoing recording of progress and ‘variance' is what differentiates an ICP from a clinical guideline.

Integrated care pathway determines locally agreed, multidisciplinary practice based on guidelines and evidence where available for a specific patient / user group. It forms all or part of the clinical record, documents the care given, and facilitates the evaluation of outcomes for continuous quality improvement.

 There are key common elements that constitute a care pathway:

• It organises the process

• There is a timeline element

• There is supportive evidence of practice

• There is an element of multidisciplinary collaboration

• There are elements of care identified usually within an agreed time frame

• There is continuous review of practice

• There is an assessment of variance

• It is outcome focussed

• It constitutes all or part of the clinical record

• The pathway should inform risk and benefit

Reference:

Overill S (1998) A practical guide to care pathways. J. Integrated Care 2,93-8