The right path to the right care

Making sure patients receive safe, reliable treatment and decreasing their length of stay are cornerstones to the provision of care at Great Ormond Street Hospital (GOSH). One way to ensure this is to apply an integrated care pathway (ICP), but what exactly does this mean? An integrated care pathway (ICP) outlines the care a patient should receive from a multidisciplinary perspective, giving a clear timeframe for that care so the patient can move smoothly and progressively though the hospital.

ICPs have been used on some wards for the past few years and are starting to be employed across the Trust where appropriate.

To help demystify them, Nathan Askew, Ward Manager on Sky Ward, explains how helpful he and his team have found them.

"An ICP prompts staff to ensure they’re doing everything they need to do,” says Nathan. “It can give patients and parents an idea of where they should be in their patient journey. It also streamlines and improves discharge and reduces length of stay just by doing simple things like ordering TTO (to take out) medication three days before discharge so that by the last day families are not waiting around for it."

If this implies an ICP is a rigid formula, it’s not. Although an ICP helps reduce unnecessary variations in patient care, there is still a degree of clinical flexibility within them to allow for individual patient conditions.

"The idea is that children undergoing the same procedure – even though every child is different – will have a similar plan of care," says Nathan.

"About 85 per cent of children with a particular condition get what they need when they need it. So if the child should eat on day one and they don’t because they’re vomiting then we just add it into day two. If after five or seven days on the pathway they’re not where they should be then the pathway ends and they transfer on to a normal nursing care plan. We have that flexibility so it’s not like you have to eat after 12 hours."

According to Nathan, having clear stages and agreed steps also assists patients and families: "We can say, 'this will come out on this day, this will be turned off on this day, you’ll be walking by this day'. It’s actually quite nice to be able to say that to them."

Nathan has been successfully working with Great Ormond Street Hospital’s Health Information and Language Manager Beki Moult on making sure ICPs are clear and accurate.

"There are so many benefits to an ICP. Not just for the children and families, not just in shortening their stay but it will also give them a guideline of where they are in their patient journey at GOSH.

"As nursing staff, medical staff and allied health professionals, there is also so much paperwork involved in the job now that it’s nice to have a clear guide of what you need for that day but also a central place to record all of that by everybody."