Collaboration across primary and secondary care dermatology services

Purpose: The paper demonstrates the complexities of leadership in a local health-care community across primary and secondary care interface, using the example of a general practitioner (GP) with a special interest role (GPwSI) in dermatology. It focuses on how the service will develop and how it could be achieved. Design: Various models and theories about change management were consulted focusing particularly on the goals of the local health-care economy, resources available and environment/contextual surroundings. Practical implications: Primary care trusts (PCTs), acute trusts and clinicians need to work collaboratively to achieve an integrated, flexible care pathway, so that patients and the PCTs can be assured of an efficient and good quality service. Conflicts between primary and secondary care dermatology services are not sustainable for a long period. Originality: The Government's agenda is a shift of care closer to people's homes, so PCTs do need to be aware of what they wish to commission, and consider moving traditional hospital-based facilities into community settings, such as walk-in centres, polyclinics and large health centres, associated with improved GP and patient education on skin problems.

Introducing clinical pathways as a strategy for improving care

This article describes the way in which Catharina Hospital introduced clinical pathways to its workforce. The hospital, one of the largest non-academic teaching hospitals in The Netherlands, developed the first clinical pathway in 2004. Since then, clinical pathways have been presented as a strategic tool for improving care. In preparation for an organization-wide project, a team investigated and adapted the methodology as designed by the Clinical Pathway Network to the specific situation of Catharina Hospital. Staff were educated, which in return provided project teams with methodology and tools for development. Started small, the aim of the project is to achieve a snowball effect in the use of clinical pathways. Having started in 2006, six pathways are currently under construction, more of which are considered for development. An evaluation of the methodology and results in the summer of 2007, showed that the method was of great help in optimizing care processes and developing multidisciplinary agreements.

Care pathway quality scorecards

This paper describes the rationale and methodology for three exercises used to critically appraise the quality of the two main tools supporting implementation of the care pathway continuous improvement methodology. The Venture care pathway journey quality scorecard and the Venture care pathway paper-document quality scorecard builds a greater understanding of the value provided by different components of content and layout. In addition, the Venture paper care pathway document template provides a basic design guide for teams, based on 20 years of experience in developing, implementing and evaluating care pathway documents.

Thrombolysis in Acute Ischaemic Stroke Pathway

Thrombolysis of appropriate and selected patients presenting with an acute ischaemic stroke within 3 h of onset with recombinant Tissue Plasminogen Activator (alteplase, r-TPA) can be implemented safely, reduce long-term disability, and is recommended by the National Institute of Health and Clinical Excellence and the Department of Health's National Stroke Strategy. We have developed an integrated and comprehensive pathway in order to achieve the above aims, which also provide guidelines for nursing in the peri-acute period and management of complications arising from the ischaemic stroke itself, from thrombolysis or from concomitant hyperglycaemia.

An academic medical centre's programme to develop clinical pathways to manage health care: focus on acute decompensated heart failure

Heart failure (HF) is a major public health issue and acute decompensated heart failure (ADHF) is a leading cause of hospitalization in the USA. The United States health care delivery system is bound by regulatory agencies requiring strict compliance to key clinical indicators, which are publicly reported. Clinical pathway development is a systematic approach to managing health care that involves a high degree of collaboration between patients, physicians, nurses and various health-care team professionals. The University of California, Irvine Medical Center (UCIMC) developed an evidence-based multidisciplinary pathway for patients with ADHF. This clinical pathway incorporates universally proven assessment and treatment measures in ADHF. Adjunctive to this process are patient and nursing guides to the ADHF pathway. Utilization of this pathway has been shown to significantly impact clinical performance by early identification of potential negative clinical outcomes. Clinical pathways, such as the ADHF pathway, promote clinical excellence in caring for acute and chronic diseases states.

Midwife–led Maternity Assessment

A system of midwife-led care supported by six integrated care documents was developed at Taunton & Somerset Hospital according to Trust guidance on ICPs. An audit at 12 months showed that >50% of women can be Cared for by midwives alone. Sample documents for antepartum haemorrhage and suspected pre-eclampsia are presented.

HIV and Pregnancy

HIV is becoming more prevalent in the UK, and is being increasingly detected in asymptomatic women during antenatal screening. Taunton & Somerset Hospital wrote an ICP document for the management of HIV in pregnancy according to their Trust policy, and it is presented here.