Integrated care pathways

Integrated care pathways are one way of managing, monitoring and recording a child’s care.

They can also be referred to as 'clinical pathways' or ‘critical pathways’, ‘care plans’, ‘care paths’ and ‘care maps’.

The European Pathway Association (EPA) defines an ICP as:

  • "a methodology for the mutual decision making and organization of care for a well-defined group of patients for a well-defined period."

Another definition is that an ICP is:

  • "a multidisciplinary management tool based healthcare plan for a specific group of patients with a predictable clinical course, in which the different tasks by the professionals involved in the patient care are defined, optimised and sequenced."

Integrated care pathways at GOSH

Guidelines have been written to help members of staff at GOSH develop integrated care pathways as part of an improvement project.

It follows the outline of improving the patient pathway published by the NHS Institute for Innovation and Improvement and is split into six phases:

  • Prepare

  • Diagnose

  • Design

  • Plan

  • Implement

  • Refine

While it is not compulsory to follow all these phases or the order in which they appear, readers should note that this framework supports the process of improvement and results in a high quality and truly multidisciplinary integrated care pathway.

Variance analysis

Variance analysis is a critical part of developing and using integrated care pathways. Variance analysis is used to measure what happens to the patient on the pathway, whether they deviate from the expected pathway and if so, for what reasons.

The resulting analysis can be used to amend the integrated care pathway itself (if, for the majority of patients, the practice is different to the pathway) or the processes followed (if a certain task is persistently not met or not met at the expected time). Where available, variance analysis is displayed with the pathway document.

The following integrated care pathways currently in use at GOSH. Please read our disclaimer (below) before opening the documents.



These pathways are intended to guide and facilitate the care of patients at Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH). The guidance contained therein is not intended to replace individual assessment and personalised treatment of the patient.

The authors attempt to base the guidance on best available evidence and ensure that content is up to date.

The pathway may not necessarily represent the views of all clinicians at GOSH.

This information may be used for private education, research and institutional education but if used for any other purposes, consent must first be obtained from GOSH. Any person intending to use the guidelines should assess the suitability of use. GOSH will not accept any responsibility for use by external agencies or individuals.

No part of this publication may be reproduced, stored in or introduced into a retrieval system or transmitted in any form without prior consent and acknowledgment of GOSH. GOSH retains copyright.

In some pathways it is necessary to use product names to ensure clarity of information or for the purpose of identifying a specific type of product or drug. Where possible, generic product names have been used in preference to trade names or trade marks.

Please be aware that use of any trade names listed in this document should not necessarily be seen as an endorsement of the product and that other similar products may be available.