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Prevalence and quality of clinical pathways in Swedish intensive care units: a national survey
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
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2014 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 20, no 1, p. 48-57Article in journal (Refereed) Published
Abstract [en]

RATIONALE, AIMS AND OBJECTIVES

To identify the prevalence of clinical pathways (CPs) in Swedish intensive care units (ICUs) and to explore the quality, content and evidence base of the documents.

METHODS

A descriptive and explorative survey of all Swedish ICUs (N84) and a review of submitted examples of CPs (n12) were conducted.

RESULTS

CPs were in use at 20% of the Swedish ICUs. There was a significant geographic variation but no relationship between the use of CPs and category of hospital, type of ICU, size of ICU or type of health record applied. In total, 56 CPs were reported within a range of scopes and extensions. The content of the ICUs' CPs, as well as the degree to which they were interprofessional, evidence based, and renewed varied.

CONCLUSIONS

Progress has been made in relation to CPs in recent years, but there is potential for further improvements. None of the ICUs had CPs that contained all key characteristics of a high-quality, interprofessional and evidence-based CP identified in the literature. Greater knowledge sharing and cooperation within the field would be beneficial, and further research is needed.

Place, publisher, year, edition, pages
2014. Vol. 20, no 1, p. 48-57
Keyword [en]
clinical pathways, evidence-based practice, intensive care, organization, professional practice, standardized care plans
National Category
Medical and Health Sciences
Research subject
Anaesthesiology and Intensive Care; Health Care Research; Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-207939DOI: 10.1111/jep.12078ISI: 000330802100008PubMedID: 24033437OAI: oai:DiVA.org:uu-207939DiVA, id: diva2:650477
Projects
Standardiserade vårdplaner inom svensk intensivvård
Available from: 2013-09-22 Created: 2013-09-21 Last updated: 2018-01-29Bibliographically approved
In thesis
1. Clinical Pathway Implementation and Teamwork in Swedish Intensive Care: Challenges in Evidence-Based Practice and Interprofessional Collaboration
Open this publication in new window or tab >>Clinical Pathway Implementation and Teamwork in Swedish Intensive Care: Challenges in Evidence-Based Practice and Interprofessional Collaboration
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Teamarbete och implementering av standardiserade vårdplaner inom svensk intensivvård : Utmaninga med interprofessionellt samarbete och evidensbaserad praktik
Abstract [en]

Suboptimal quality of care is an evident issue in current healthcare services. Clinical pathways (CPs) have the potential to facilitate evidence-based practice and interprofessional teamwork, and thereby improve patient safety and quality of care.

The overall aim of the thesis was to develop comprehensive empirical knowledge and understanding of CP implementation and teamwork in Swedish intensive care units (ICUs). Four studies were included (I-IV).

Study I was a survey including all Swedish ICUs (N84) and a document analysis of CP examples (n12). In total, 17 (20%) ICUs used CPs and many had implementation plans. The quality, extent and content of the CPs (n56) varied greatly, with sometimes insufficient interprofessionalism, evidence base and renewal.

Study II was a mixed method including ICUs using CPs. The implementation processes were retrospectively explored through questionnaire data (n15) and qualitative content analysis of interviews with key informants (n10). The CP implementation was revealed as a process directed at realizing the usefulness and creating new habits, which requires enthusiasm, support and time.

Studies III and IV were grounded theory studies in an action research project in an ICU. Study III explored everyday teamwork through focus group interviews with registered nurses, assistant nurses and anesthesiologists, as well as an individual interview with a physiotherapist (n38). Teamwork was revealed as an act of ‘balancing intertwined responsibilities.’ The type of teamwork fluctuated as the team processes were affected by circumstantial factors and involved individuals. Study IV prospectively explored the implementation process of a CP during a five-year period through repeated focus groups and individual interviews, questionnaires and logbooks/field notes, including the interprofessional project group, staff and managers (n71), and retrospective screening of health records (n136). ‘Struggling for a feasible tool’ was revealed as a central phenomenon. The implementation process included contextual and processual circumstances that enforced negotiations to achieve progress, which made the process tentative and prolonged and had consequences on the process output.

In conclusion, CP implementation processes are affected by multiple interplaying factors. Although progress has been achieved in evidence-based practice and interprofessional collaboration there is still potential for substantial improvements, emphasizing a need for further facilitation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 89
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1425
Keyword
Desicion support, Standardized care plans, Research utilization, Organisation, Caring sciences, Beslutstöd, Vårdplanering, Organisation, Forskningsanvändning, Vårdvetenskap
National Category
Anesthesiology and Intensive Care
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-339967 (URN)978-91-513-0227-0 (ISBN)
Public defence
2018-03-23, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-02-26 Created: 2018-01-29 Last updated: 2018-04-03

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Bjurling-Sjöberg, 2014(643 kB)273 downloads
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Bjurling-Sjöberg, PetronellaWadensten, BarbroPöder, Ulrika

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