Integrated care pathways.

Integrated care pathways specify and evaluate clinical practice and can improve patient care.' They use multidisciplinary guidelines to develop and implement clinical plans which represents current, local best practice for specific conditions. They may also incorporate national guidelines,' evidence based medicine,3" and benchmarking.5 Pathways are divided into time intervals during which specific goals and expected progress are indicated, together with guidance on the optimal timing of appropriate investigations and treatment (fig 1).' Pathways are usually unique to the institution in which they are developed. This is partly because they reflect details of care which vary between institutions, but also because the development of the pathway allows evaluation of current practice and results in clarification and coordination of the overall plan of care. However, exchange of information between health professionals using similar pathways can be extremely valuable to improve and extend the use of pathways. They have been used in paediatric surgery, cardiology, neonatology, and for medical conditions such as asthma, diabetes, and leukaemia.' 6