The use of critical pathways in caring for schizophrenic patients in a mental hospital

Integrated Care Pathways for Schizophrenia: A Scoping Review

This paper summarizes the existing evidence for integrated care pathways (ICPs) for the treatment of schizophrenia. Scoping review methods following PRISMA guidelines were employed due to the variable nature of the evidence in this area. The review identified 13 papers. Of these papers, 7 focused on describing ICP content and process-related data and 6 examined clinical outcomes. Of the 6 studies providing outcome data, 2 reported improved outcomes associated with ICPs. Conceptually, ICPs hold great promise for improving the quality of schizophrenia care. However, in contrast with other specialty healthcare domains, the schizophrenia ICP evidence base is very limited and has not fulsomely begun to address ICPs for effectiveness.

Development of a clinical pathway for long-term inpatients with schizophrenia

Clinical pathways have been defined as an optimal sequencing and timing of interventions by staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care and minimize delays. The aim of the present study was to develop a clinical pathway for long-term inpatients with schizophrenia. A review of clinical records was conducted for 17 patients with schizophrenia who had stayed in one psychiatric hospital for >1 year, and who remained in the community >3 months after hospital discharge. A review of clinical routine records was conducted. The discharge process of each patient was expressed in a clinical pathway around phases and care components. They were integrated into one clinical pathway. The discharge process was divided into assessment and goalsetting, preparation, and discharge phases. Care components included discharge planning, daily activity, living environment, health management, and basic life skills. Discharge planning was an important care component that was combined with all three phases. A clinical pathway was developed from reviewing past patient records, and discharge planning was found to be an important care component, which was combined with all three phases: assessment and goalsetting, preparation, and discharge. Further study is needed to examine the validity of the pathway for use in other hospitals.

Care programmes and integrated care pathways

PURPOSE

The article discusses how care programmes and integrated care pathways can be linked, finding ways to improve healthcare process professional and logistical quality from a supply chain and a network point-of-view.

DESIGN/METHODOLOGY/APPROACH

The authors argue that owing to cost containment goals and increasing healthcare demand, healthcare services systems are challenged to improve service quality, whilst at the same time finding ways to improve delivery processes. It explores if the combination of two instruments, care programmes and integrated care pathways, can meet both goals. This combination is illustrated by an example from the Institute of Mental Health Care Eindhoven en de Kempen.

FINDINGS

Analysis suggests that care programmes can be combined with integrated care pathways, leading to a situation where both quality and process improvement can be reached. These instruments are complementary.

RESEARCH LIMITATIONS/IMPLICATIONS

The article is largely conceptual; ideas are presented to stimulate thinking rather than to prove an argument.

PRACTICAL IMPLICATIONS

Combining care programmes and integrated care pathways has implications for the way we think about and organise healthcare processes.

ORIGINALITY/VALUE

There have been few publications on instruments combining both a network and a supply chain approach to describe and understand healthcare processes.

Effects of introducing a critical path method to standardize treatment and nursing for early discharge from acute psychiatry unit

This research aimed to examine whether early discharge can be performed by nurses of a ward participating in the process of critical path method supporting with offer and evaluation of standard and efficient medical treatments and nursing cares. In order to enrich the system that performs hospitable medical treatment and nursing cares standardized at the psychiatry acute term and to prevent chronic, critical path method was introduced into the acute term ward, then the investigation for nursing job satisfaction that was important to establish critical path method was conducted. By introducing critical path method, it became possible to assess the patients in standard, and the subject of business or a system became clear towards early discharge. It became possible to tie up this subject to a future improvement. Consequently, as for comparison of the patient who applied the schedule table of critical path method at the first and second term, the latter decreased the average length of hospitalization period significantly. The satisfaction of the task requirement, which was important to maintain systems, was decreased by the introduction of critical path method but the score of autonomy in satisfaction increased significantly by the improvement of usage of critical path method. From these, it was suggested that the introduction of critical path method in the acute-care unit psychiatry had possibility to aim at standardization of treatment and nursing and patients' early discharge from hospitals.

Evaluation of a community mental health carepath for early psychosis

PURPOSE

To implement a carepath for early psychosis across all community mental health centres through the Early Psychosis Intervention Programme in the Fraser South Area of British Columbia, Canada.

METHODS

Prior to developing the carepath, chart reviews and interviews were performed to assess for adherence to published guidelines for early psychosis intervention. This assessment revealed the inadequacies of narrative recording and that core psychosocial interventions were inconsistently provided. The carepath developed included prompts for interventions and standardized assessments and ultimately replaced the charting system used in the mental health centres for early psychosis clients.

RESULTS AND CONCLUSIONS

One-year evaluation revealed some improvements in clinical practice but also identified other areas that require further improvement. This project demonstrated that it is possible to successfully implement a carepath in community mental health and that doing so provides a standardized method for ongoing improvements in care.

Language, therapeutic relationships and individualized care: addressing these issues in mental health care pathways

Care pathways are used extensively in inpatient medical and surgical services to facilitate the delivery of evidence-based health care. There is a growing interest in their use in the mental health arena. However, questions remain about their acceptability to service users and staff. Most current literature is aimed at communicating the value of care pathways. Consequently, issues that are particularly pertinent to mental health, like language, therapeutic relationships and individualized care have not been fully addressed. This paper reports on the development of a care pathway in residential services in Nottingham. It will illustrate how by working in multidisciplinary groups with service users and carers these issues were incorporated into a comprehensive pathway that follows the service user's journey from admission to discharge. The paper concludes by highlighting some of the challenges of care pathway implementation and suggests ways they can be overcome.

A tale of three pathways: the experience of RBWH Mental Health

OBJECTIVES

Australian research has identified that there are significant variations between service providers in terms of clinical management of patients with comparable presenting problems. Internal audits within the facility at Royal Brisbane and Women's Hospital revealed that these variations occurred between wards, treating teams and psychiatric consultants. Given the increasing emphasis on evidence-based practice, it was decided that the literature should be reviewed to determine what the standard of care should be. The paper then examines how clinical pathways for psychosis and for depression were developed and how they eventually evolved into an acute inpatient pathway. It identifies the framework used and examines important aspects relating to the adaptation of these frameworks to mental health issues. The process for the development and implementation of the clinical pathway is discussed. Recommendations for their future use in a mental health setting are also presented.

CONCLUSIONS

Mental Health care is complex. For this reason, mental health clinical pathways have to remain flexible and innovative. With the present project, it was found that the pathways were not suited for specific diagnoses so that they evolved into a single acute inpatient pathway.

Psychiatric nursing case management: past, present, and future

This literature review examines the evolution of psychiatric nursing case management in the United States. Various models, both inpatient and outpatient, are described, along with the roles of the case manager in each setting. The development of clinical pathways to monitor and document outcomes in acute settings is examined, along with the difficulties in adapting them specifically to psychiatric nursing case management. The types of data collected and the use of outcomes to support programs for the mentally ill are reviewed. Finally, recommendations for psychiatric nursing case management are made to provide guidelines for the future.