Integrated care pathways for vascular surgery

Objectives: a trial of the use of integrated care pathways (ICPs) for elect ive vascular surgical procedures. Design: a 12-month prospective study, following a multi-disciplinary group construction of current "best practice" ICPs, with changes in practice only occurring following careful audit of results. Materials: patients admitted to a single vascular unit for "open" repair of abdominal aortic aneurysm, carotid endarterectomy or femoropopliteal bypas s grafting. Methods: patients followed ICPs on a daily basis with signatures required t o confirm that action had been taken and careful recording of variances fro m the ICPs. Audit of variance data allowed changes in the ICPs and, hence, provision of the best possible nursing and clinical practice. Results: ICPs were well received by patients and staff. They improved commu nication, promoted an appreciation of each health group's role in patient c are, increased nursing autonomy, reduced calls to junior. medical staff, im proved patient education and confidence and caused a marked reduction in ho spital "length of stay". Conclusions: ICPs have clear benefits. This study realises that benefits mi ght be maximal for high throughput, high-cost procedures. Successful use of ICPs depends upon "clinical champions" and effective project management. S ufficient resource and training are essential.