Lesson 1, Topic 1
In Progress

Nursing Diagnoses and Clinical Pathways

May 1, 2021

To practice in the changing world of health care today, nurses are called on to go beyond performing technical skills and providing direct patient care. Responsibilities include working with outcomes, cost, resources, and other members of the health care team. One way of addressing cost containment issues is through managed care. Managed care refers to health care systems that have control over primary health care services and attempt to trim down health care costs by reducing unnecessary or overlapping services; an emphasis is placed on health promotion, education, and preventative medicine. Case management is one way managed care is achieved in a health care setting. Case management encompasses planning, coordination of care, and patient advocacy in providing quality, cost-effective outcomes for the patient. The case management system of care allows for continuity in care because one person coordinates the plan of care for an individual patient within the health care setting, including discharge planning.

Case management usually depends on the use of clinical pathways. A clinical pathway is a multidisciplinary plan that incorporates evidence-based practice guidelines for high-risk, high-volume, high-cost types of cases while providing for optimal patient outcomes and maximized clinical efficiency. Synonyms for clinical pathways are critical pathways, multidisciplinary action plans, action plans, and care maps. The clinical pathway guides care with coordination of actions from disciplines such as nursing, medicine, pharmacy, social services, dietary therapy, and physical therapy to develop the plan of care. Reduced complications and improved documentation, decreased costs, and decreased time the patient is in the health care setting are potential benefits of the use of clinical pathways (Rotter et al., 2010). When a patient does not achieve the projected outcome, a variance, or exit, is said to have occurred. Variances and exits are examined by members of the multidisciplinary team to determine whether the failure to achieve the outcome was a problem with the system, the provider, or the patient (Craven and Hirnle, 2012). Variance analysis is then used to promote continuous quality improvement. Repetition of variances often leads the health care team to revise a clinical pathway.
Whether the health care facility uses the traditional care plan, clinical pathways, or another system for organizing care, the goal remains the same: efficient care with positive patient outcomes. In addition, the nurse and all health care professionals must be cognizant of cost containment when providing care.