Tumour necrosis factor (TNF) blockers are effective in the treatment of rheumatoid arthritis. These drugs are expensive, however, and there is uncertainty over their long-term safety. The National Institute for Clinical Excellence has issued guidance over the use of these drugs in rheumatoid arthritis. The Royal National Hospital for Rheumatic Diseases developed an integrated care pathway following the patient's journey from referral to the TNF services until the administration and continued monitoring of their response in accordance with NICE Guidance, taking into account local issues. This paper reviews the development and implementation of this pathway.
{"title":"Care Pathway for TNF α-Blockers for Patients with Rheumatoid Arthritis at the Royal National Hospital for Rheumatic Diseases","authors":"N. Shenker, C. Fokke, Elizabeth Michell","doi":"10.1258/J.JICP.2005.114","DOIUrl":"https://doi.org/10.1258/J.JICP.2005.114","url":null,"abstract":"Tumour necrosis factor (TNF) blockers are effective in the treatment of rheumatoid arthritis. These drugs are expensive, however, and there is uncertainty over their long-term safety. The National Institute for Clinical Excellence has issued guidance over the use of these drugs in rheumatoid arthritis. The Royal National Hospital for Rheumatic Diseases developed an integrated care pathway following the patient's journey from referral to the TNF services until the administration and continued monitoring of their response in accordance with NICE Guidance, taking into account local issues. This paper reviews the development and implementation of this pathway.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132965324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-12-01DOI: 10.1177/147322970500900310
S. Groom
During the many quality and informative presentations made at the Risk 2005 conference held in London last month, a common theme emerged from many of the speakers, which highlighted the need to adopt systematic, repeatable and measurable reporting to support the vast array of risk priorities and agendas. Professor Clive Vincent, who addressed delegates with a presentation that highlighted the need for systematic collection of data by frontline staff, broached this view at the start of the conference. He commented that today 'the relevance of instant reporting is dismissed out of hand', a situation that will have to change, but which he recognized was mainly due to a culture founded in a strong resistance to change. But he also recognized that this task was not easy and made reference to a report written in 1863, which noted that even then, professionals were placing an emphasis on data and its collection, for use in reporting. Karen Taylor, Director of the National Audit Office (NAO) also underpinned the importance of collecting information systematically, and supported Professor Vincent's observation that many health-care professionals were grappling with how to achieve these goals. Karen outlined a number of drivers and initiatives that could be used to gain funds to promote good recording and reporting, including the Health 'Value for money' Audit carrot, or the exposure to Litigation Authority assessments stick. Her presentation introduced the NAO's research finding compiled in conjunction with Strathclyde University, on the study of Hospital Infections and the associated risks, and concluded that good practice 'happened in isolation' in most hospitals. She accepted that new systems such as the National Programme for IT (NPtlT) would help, but warned those delegates who believed that it was the panacea to their reporting problems, and that the programme objectives would not solve all the issues. She highlighted that in a comprehensive plan to provide reporting and recording systems, the initiatives and agendas needed to include measurement and training. Karen used the NAO's findings related to the trammg of nonexecutives at trust level as a pertinent example, suggesting that part of any programme must include the training of executive teams in their responsibilities to support these critical agendas. This idea supported and confirmed Professor Vincent's view that one route to success was the development of a plan at executive level, which encompassed the key components of a systematic approach to reporting, and which included:
{"title":"Risk 2005","authors":"S. Groom","doi":"10.1177/147322970500900310","DOIUrl":"https://doi.org/10.1177/147322970500900310","url":null,"abstract":"During the many quality and informative presentations made at the Risk 2005 conference held in London last month, a common theme emerged from many of the speakers, which highlighted the need to adopt systematic, repeatable and measurable reporting to support the vast array of risk priorities and agendas. Professor Clive Vincent, who addressed delegates with a presentation that highlighted the need for systematic collection of data by frontline staff, broached this view at the start of the conference. He commented that today 'the relevance of instant reporting is dismissed out of hand', a situation that will have to change, but which he recognized was mainly due to a culture founded in a strong resistance to change. But he also recognized that this task was not easy and made reference to a report written in 1863, which noted that even then, professionals were placing an emphasis on data and its collection, for use in reporting. Karen Taylor, Director of the National Audit Office (NAO) also underpinned the importance of collecting information systematically, and supported Professor Vincent's observation that many health-care professionals were grappling with how to achieve these goals. Karen outlined a number of drivers and initiatives that could be used to gain funds to promote good recording and reporting, including the Health 'Value for money' Audit carrot, or the exposure to Litigation Authority assessments stick. Her presentation introduced the NAO's research finding compiled in conjunction with Strathclyde University, on the study of Hospital Infections and the associated risks, and concluded that good practice 'happened in isolation' in most hospitals. She accepted that new systems such as the National Programme for IT (NPtlT) would help, but warned those delegates who believed that it was the panacea to their reporting problems, and that the programme objectives would not solve all the issues. She highlighted that in a comprehensive plan to provide reporting and recording systems, the initiatives and agendas needed to include measurement and training. Karen used the NAO's findings related to the trammg of nonexecutives at trust level as a pertinent example, suggesting that part of any programme must include the training of executive teams in their responsibilities to support these critical agendas. This idea supported and confirmed Professor Vincent's view that one route to success was the development of a plan at executive level, which encompassed the key components of a systematic approach to reporting, and which included:","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"9 6 Suppl 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116797307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-12-01DOI: 10.1177/147322970500900302
R. Grant, Julie E. Hall, Roger Pritlove
This is the second paper of two, which considers the development, use and evaluation of an integrated care pathway (ICP) for acute inpatient mental health care. This paper reports an evaluation that was carried out to measure the impact of an ICP (described in Part 1) on the interventions it was designed to guide. The methodology used was pre- and post-ICP comparison of activities/care recorded in health-care records using delineating measures. Data were gathered from the notes of 23 service-users who had two inpatient stays within a year, one pre-ICP and one post-ICP. The findings suggested an overall improved provision of interventions, although as the ICP progressed the likelihood of receiving interventions fell. Three specific aspects were not affected by the ICP, these were giving information about observation levels to service-users, care planning and medical interventions. These issues are discussed and the conclusion raise implications for further ICP development and implementation.
{"title":"Is Everything in the Garden Rosy? An Integrated Care Pathway for Acute Inpatient Mental Health Care, from Development to Evaluation: Part 2","authors":"R. Grant, Julie E. Hall, Roger Pritlove","doi":"10.1177/147322970500900302","DOIUrl":"https://doi.org/10.1177/147322970500900302","url":null,"abstract":"This is the second paper of two, which considers the development, use and evaluation of an integrated care pathway (ICP) for acute inpatient mental health care. This paper reports an evaluation that was carried out to measure the impact of an ICP (described in Part 1) on the interventions it was designed to guide. The methodology used was pre- and post-ICP comparison of activities/care recorded in health-care records using delineating measures. Data were gathered from the notes of 23 service-users who had two inpatient stays within a year, one pre-ICP and one post-ICP. The findings suggested an overall improved provision of interventions, although as the ICP progressed the likelihood of receiving interventions fell. Three specific aspects were not affected by the ICP, these were giving information about observation levels to service-users, care planning and medical interventions. These issues are discussed and the conclusion raise implications for further ICP development and implementation.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"535 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116708799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-12-01DOI: 10.1177/147322970500900308
L. Ashelby, R. Fox
{"title":"Elective Caesarean Section","authors":"L. Ashelby, R. Fox","doi":"10.1177/147322970500900308","DOIUrl":"https://doi.org/10.1177/147322970500900308","url":null,"abstract":"","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133200458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Critical path and process-mapping methodology was used in industry, particularly in the field of engineering from as early as the 1950s. In the 1980s, clinicians in the USA began to develop the pathway tool within managed care; they were re-defining the delivery of care and attempting to identify measurable outcomes. They were focusing on the patient rather than the system, but needed to demonstrate efficient processes in order to fulfill the requirements of the insurance industry. In the early 1990s the National Health Service (NHS) in the UK funded a patient-focused initiative to support organizational change. This resulted in the investigation and development of concepts such as pathways. In 1990, a team from the UK visited the USA to investigate the use of these pathways, or ‘Anticipated Recovery Pathways’ as they were then called. As a result of this visit, 12 pilot sites for pathways were set up in Northwest London in 1991–92. The West Midlands Pathway Development work also got underway. By 1994, the Anticipated Recovery Pathway had evolved into the Integrated Care Pathway (ICP) in the UK. ICPs were clinician led and driven, and had patients and locally agreed, best practice at their heart. In response to demand for a coordinated UK ICP users group, the National Pathways User Group (later re-named the National Pathways Association [NPA]) was set up in 1994. A popular and well-supported group, it finally folded in 2002, a casualty of the time required by volunteers to lead the group and administer its running. In 2002, at about the same time that the NPA folded, the National Electronic Library for Health (NeLH) Pathways Database was launched to enable the free sharing of ICPs and ICP projects across the UK. Since 1991, ICPs have been developed and implemented across all health care settings in the UK (acute, community, primary, mental health, private, independent, NHS). ICPs are now used all around the world including Africa, Australia, Belgium, Canada, Denmark, Germany, Hong Kong, Italy, the Netherlands, New Zealand, the UK, and the USA. However, the UK has formalized the systematic development, implementation and use of care pathways by embedding them in national policy, identifying them as the vehicle for implementation, demonstration/monitoring and evaluation of all health and social care policies, strategies, initiatives and agendas at the frontline.
{"title":"A Voice for the UK Care Pathway Community of Practice","authors":"J. Gray","doi":"10.1258/J.JICP.2005.102","DOIUrl":"https://doi.org/10.1258/J.JICP.2005.102","url":null,"abstract":"Critical path and process-mapping methodology was used in industry, particularly in the field of engineering from as early as the 1950s. In the 1980s, clinicians in the USA began to develop the pathway tool within managed care; they were re-defining the delivery of care and attempting to identify measurable outcomes. They were focusing on the patient rather than the system, but needed to demonstrate efficient processes in order to fulfill the requirements of the insurance industry. In the early 1990s the National Health Service (NHS) in the UK funded a patient-focused initiative to support organizational change. This resulted in the investigation and development of concepts such as pathways. In 1990, a team from the UK visited the USA to investigate the use of these pathways, or ‘Anticipated Recovery Pathways’ as they were then called. As a result of this visit, 12 pilot sites for pathways were set up in Northwest London in 1991–92. The West Midlands Pathway Development work also got underway. By 1994, the Anticipated Recovery Pathway had evolved into the Integrated Care Pathway (ICP) in the UK. ICPs were clinician led and driven, and had patients and locally agreed, best practice at their heart. In response to demand for a coordinated UK ICP users group, the National Pathways User Group (later re-named the National Pathways Association [NPA]) was set up in 1994. A popular and well-supported group, it finally folded in 2002, a casualty of the time required by volunteers to lead the group and administer its running. In 2002, at about the same time that the NPA folded, the National Electronic Library for Health (NeLH) Pathways Database was launched to enable the free sharing of ICPs and ICP projects across the UK. Since 1991, ICPs have been developed and implemented across all health care settings in the UK (acute, community, primary, mental health, private, independent, NHS). ICPs are now used all around the world including Africa, Australia, Belgium, Canada, Denmark, Germany, Hong Kong, Italy, the Netherlands, New Zealand, the UK, and the USA. However, the UK has formalized the systematic development, implementation and use of care pathways by embedding them in national policy, identifying them as the vehicle for implementation, demonstration/monitoring and evaluation of all health and social care policies, strategies, initiatives and agendas at the frontline.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116098314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-12-01DOI: 10.1177/147322970500900304
R. Durai, K. Subramonian, R. Ravi, I. Dickinson
Objective: An audit was conducted to find out whether there is any unnecessary delay in discharging patients after transurethral resection of the prostate (TURP). Methods: About 94 patients who underwent elective TURP over a period of seven months between April 2002 and October 2002 at Darent Valley Hospital were selected. Details were collected from the case-notes retrospectively. Results: The mean age of patients was 72.71 (range 57–90) and the mean postoperative hospital stay was 4.7 days (range 2–20). In all, 30 patients stayed for less than three days and 64 (68.1%) patients stayed for longer duration. Among these 64, 37 had underlying reasons for their prolonged stay and 27 (42%) had no obvious reason for their delay in discharge. Among these 27 (mean stay − 4.42 days), 16 (59.25%) were operated upon on Friday, eight (29.62%) on Thursday, three (11%) on Wednesday and none were operated upon on Monday. Discussion: Patients undergoing operations on Thursday and Friday stayed longer because of lack of urological cover during the weekend. Complications such as urinary tract infection (UTI) and excess bleeding can be minimized by implementing strict preoperative urine culture, antibiotic prophylaxis and spending a little extra time on haemostasis. If a patient fails his trial without a catheter it should not be removed again during the same admission. An anticoagulation nurse can help to reduce the stay for patients on warfarin. Nurses and junior doctors should be taught about how to reduce postoperative stay after TURP. A new care pathway, which allows nurses to remove the catheter without waiting for instructions, may be useful. A prospective audit is recommended.
{"title":"What Happens When There is No Weekend Urology Cover? An Audit and Formation of a New Care Pathway","authors":"R. Durai, K. Subramonian, R. Ravi, I. Dickinson","doi":"10.1177/147322970500900304","DOIUrl":"https://doi.org/10.1177/147322970500900304","url":null,"abstract":"Objective: An audit was conducted to find out whether there is any unnecessary delay in discharging patients after transurethral resection of the prostate (TURP). Methods: About 94 patients who underwent elective TURP over a period of seven months between April 2002 and October 2002 at Darent Valley Hospital were selected. Details were collected from the case-notes retrospectively. Results: The mean age of patients was 72.71 (range 57–90) and the mean postoperative hospital stay was 4.7 days (range 2–20). In all, 30 patients stayed for less than three days and 64 (68.1%) patients stayed for longer duration. Among these 64, 37 had underlying reasons for their prolonged stay and 27 (42%) had no obvious reason for their delay in discharge. Among these 27 (mean stay − 4.42 days), 16 (59.25%) were operated upon on Friday, eight (29.62%) on Thursday, three (11%) on Wednesday and none were operated upon on Monday. Discussion: Patients undergoing operations on Thursday and Friday stayed longer because of lack of urological cover during the weekend. Complications such as urinary tract infection (UTI) and excess bleeding can be minimized by implementing strict preoperative urine culture, antibiotic prophylaxis and spending a little extra time on haemostasis. If a patient fails his trial without a catheter it should not be removed again during the same admission. An anticoagulation nurse can help to reduce the stay for patients on warfarin. Nurses and junior doctors should be taught about how to reduce postoperative stay after TURP. A new care pathway, which allows nurses to remove the catheter without waiting for instructions, may be useful. A prospective audit is recommended.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"115 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116597207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To assess quality of documentation in the fractured neck of femur pathway and to target problem areas with its use. Methods: Review of notes of all patients presenting to St Helier with a fractured neck of femur between 1 June and 31 August 2003. Results: Overall, doctors were worst at using the pathway; nurses were variable; physiotherapists were excellent. Several sections were underused or not used at all. A very low percentage managed to sign, date and include the patient's name. Conclusions: Better education, particularly of junior doctors, about how and why to use these documents and file them properly should eliminate the majority of problems with the use of the integrated care pathway.
{"title":"Audit of Fractured Neck of Femur Integrated Care Pathway","authors":"M. Hempling, A. Adhikari","doi":"10.1258/J.JICP.2005.112","DOIUrl":"https://doi.org/10.1258/J.JICP.2005.112","url":null,"abstract":"Objectives: To assess quality of documentation in the fractured neck of femur pathway and to target problem areas with its use. Methods: Review of notes of all patients presenting to St Helier with a fractured neck of femur between 1 June and 31 August 2003. Results: Overall, doctors were worst at using the pathway; nurses were variable; physiotherapists were excellent. Several sections were underused or not used at all. A very low percentage managed to sign, date and include the patient's name. Conclusions: Better education, particularly of junior doctors, about how and why to use these documents and file them properly should eliminate the majority of problems with the use of the integrated care pathway.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"48 13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124157885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-12-01DOI: 10.1177/147322970500900309
M. McAloon, D. Tolson, W. Reid
Quality of care has long been a driving force in services within the NHS. Current policy drivers such as clinical governance have encouraged health-care professionals to develop evidence-based high-quality models of care. Here we describe the development and implementation of a generic integrated care pathway (ICP) designed to enhance the quality of care provided throughout the Department of Medicine for the Elderly in a general hospital. The department comprised approximately 120 beds, which focused on assessment and rehabilitation of the older people following acute hospital admission. The described pathway is unusual in that it takes a broad interdisciplinary and multiagency view of care needs rather than a diseaseor problem-specific perspective. It was developed as one element of an action research study seeking to promote evidence-based nursing practice.
{"title":"Overview of the Development of a Generic Integrated Care Pathway in a Department of Medicine for the Elderly","authors":"M. McAloon, D. Tolson, W. Reid","doi":"10.1177/147322970500900309","DOIUrl":"https://doi.org/10.1177/147322970500900309","url":null,"abstract":"Quality of care has long been a driving force in services within the NHS. Current policy drivers such as clinical governance have encouraged health-care professionals to develop evidence-based high-quality models of care. Here we describe the development and implementation of a generic integrated care pathway (ICP) designed to enhance the quality of care provided throughout the Department of Medicine for the Elderly in a general hospital. The department comprised approximately 120 beds, which focused on assessment and rehabilitation of the older people following acute hospital admission. The described pathway is unusual in that it takes a broad interdisciplinary and multiagency view of care needs rather than a diseaseor problem-specific perspective. It was developed as one element of an action research study seeking to promote evidence-based nursing practice.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133651210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-12-01DOI: 10.1177/147322970500900307
D. Simkiss
Background: There are currently major national drivers set out in the Children Act 2004 and the National Service Framework for Children, Young People and Maternity Services that require closer working between statutory agencies, the voluntary sector and young people. Integrated care pathway methodology was used to improve the coordination of health assessments for looked after children. Methods: A working group of looked after children, health, education and social-care professionals, and a care pathway facilitator was established. Meetings were held with all interested parties. National guidance, ‘Promoting the Health of Looked After Children’, was incorporated into a process map for this service in Birmingham. Results: The outcomes include the process itself and a set of operational products. The process enabled young people and different professionals to better understand each other's roles and perspectives. The operational products included a process map and detailed care pathway, new health assessment documentation, an audit tool and a variance reporting strategy. Conclusions: An integrated care pathway process is a useful tool in facilitating closer working between agencies and young people. It can establish inter-agency governance procedures fundamental to delivering a Children's Trust model of working.
{"title":"Integrated Care Pathway to Promote the Health of Looked after Children","authors":"D. Simkiss","doi":"10.1177/147322970500900307","DOIUrl":"https://doi.org/10.1177/147322970500900307","url":null,"abstract":"Background: There are currently major national drivers set out in the Children Act 2004 and the National Service Framework for Children, Young People and Maternity Services that require closer working between statutory agencies, the voluntary sector and young people. Integrated care pathway methodology was used to improve the coordination of health assessments for looked after children. Methods: A working group of looked after children, health, education and social-care professionals, and a care pathway facilitator was established. Meetings were held with all interested parties. National guidance, ‘Promoting the Health of Looked After Children’, was incorporated into a process map for this service in Birmingham. Results: The outcomes include the process itself and a set of operational products. The process enabled young people and different professionals to better understand each other's roles and perspectives. The operational products included a process map and detailed care pathway, new health assessment documentation, an audit tool and a variance reporting strategy. Conclusions: An integrated care pathway process is a useful tool in facilitating closer working between agencies and young people. It can establish inter-agency governance procedures fundamental to delivering a Children's Trust model of working.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129245766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2005-12-01DOI: 10.1177/147322970500900311
A. Turner
Communication in medicine is an interesting topic at many levels and this subject is very pertinent today as the skill of communication is now given much more emphasis within foundation medical training in Britain. Communication for Doctors is a North Atlantic book and the use of American English may obscure, for some, the very useful observations and narratives related to medical communication. The language, coupled with the plain format does little to entice the reader to sample the many interesting facts and observations in each chapter. My most recent experience of the medical profession indicates that communication with patients is a huge area of discontent. The recent experience of using nurse consultants within National Health Service (NHS) community services alongside general practitioners indicates that people value the extra time that nurses can give them, to talk and listen. All the contributors use an essay-type approach, which seems curious for a book on communication. This style often lessens the message the writers are trying to convey. It also requires the reader to trawl through the text, making it difficult for readers with restricted time to grasp the overall message. However, despite the format, many of the essays are very readable and pertinent to the very real requirement for doctors to communicate effectively with their patients, whatever the patient's ability with the written and verbal word. John Garland's contribution related to recognizing and avoiding non-verbal cues that doctors give to their patients, highlights that in America, 21% of native-born adults cannot read a newspaper front page, and that 48% of adults cannot read a timetable. This startling set of facts ought to give adequate warning signals to doctors to adjust their communication style. Mark Houchausers article on the mystery of language is similarly fascinating. His review of the most frequently used words in reports is linked to the words' 'understandability'. His point that patients might be able to read the words on their medical reports, but not be able to understand them, is a point well made. Overall, this book is an easy book to 'dip' into and some of the subject matter is fascinating. However, some of the presentation factors such as the lack of a clear chapter system reduce the usefulness of the book as a means of communication itself.
{"title":"Book Review: Communication for Doctors — How to Improve Patient Care and Minimize Legal Risks","authors":"A. Turner","doi":"10.1177/147322970500900311","DOIUrl":"https://doi.org/10.1177/147322970500900311","url":null,"abstract":"Communication in medicine is an interesting topic at many levels and this subject is very pertinent today as the skill of communication is now given much more emphasis within foundation medical training in Britain. Communication for Doctors is a North Atlantic book and the use of American English may obscure, for some, the very useful observations and narratives related to medical communication. The language, coupled with the plain format does little to entice the reader to sample the many interesting facts and observations in each chapter. My most recent experience of the medical profession indicates that communication with patients is a huge area of discontent. The recent experience of using nurse consultants within National Health Service (NHS) community services alongside general practitioners indicates that people value the extra time that nurses can give them, to talk and listen. All the contributors use an essay-type approach, which seems curious for a book on communication. This style often lessens the message the writers are trying to convey. It also requires the reader to trawl through the text, making it difficult for readers with restricted time to grasp the overall message. However, despite the format, many of the essays are very readable and pertinent to the very real requirement for doctors to communicate effectively with their patients, whatever the patient's ability with the written and verbal word. John Garland's contribution related to recognizing and avoiding non-verbal cues that doctors give to their patients, highlights that in America, 21% of native-born adults cannot read a newspaper front page, and that 48% of adults cannot read a timetable. This startling set of facts ought to give adequate warning signals to doctors to adjust their communication style. Mark Houchausers article on the mystery of language is similarly fascinating. His review of the most frequently used words in reports is linked to the words' 'understandability'. His point that patients might be able to read the words on their medical reports, but not be able to understand them, is a point well made. Overall, this book is an easy book to 'dip' into and some of the subject matter is fascinating. However, some of the presentation factors such as the lack of a clear chapter system reduce the usefulness of the book as a means of communication itself.","PeriodicalId":114083,"journal":{"name":"International Journal of Care Pathways","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2005-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125746219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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