From Clinical Practice Guidelines to Clinical Pathways as Patient Care Standard

Dr. Henry Chan


Rendering quality health care to patients is the main goal of every health care professional. However, to ensure quality, the health care provided should be based on accepted standards of quality. Quality health care is therefore a measure of the degree to which a health care service conforms or achieves the agreed quality standards or indicators (NLM 2008). In practice, these quality standards are known as clinical practice guidelines.

Clinical guidelines are systematically developed statements to assist medical practitioners and patients to make decisions about the appropriate health care for a specific clinical situation. They are directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care, decisions regarding diagnosis, therapy or related clinical circumstances. They may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. They are usually developed at national level and are usually based on research evidence and judgments of experts.

However, the problem with such guidelines is that they are too general and don’t address geographical variations in clinical practice (Huttin, 1997). Henceforth, clinical practice guidelines are NOT strict rules to follow. Hospitals tend to adopt their own guidelines in order to make clinical practices within the scope of a specific institution and with its own specific population of patients, specific group of physicians, and specific access to various types of tests. This institution-based guideline is most often called as clinical pathway or clinical path or care path. It outlines a time line of clinical goals that patient should obtain during hospitalization along with the optimal sequence and timing of interventions by hospital staff to attain those goals.

Therefore the integrated clinical pathways describe, for a specific clinical condition, the tasks to be carried out together with the timing and sequence of these tasks and the discipline involved in completing the task. With this in mind, the medical practitioners and paramedical professionals should work harmoniously as a team in order for a clinical pathway of a certain clinical condition to be successfully carried out and in so doing, achieve QUALITY HEALTH CARE!