1. Lockhart, Lisa MHA, MSN, RN, NE-BC

Article Content

Q: What are critical pathways?

A: Critical pathways-also known as clinical pathways, multidisciplinary pathways, collaborative paths, or care maps to name a few-utilize evidence-based practice and apply it to structured, multidisciplinary care tracts to provide guidelines for protocols and best practice. These pathways give caregivers guidance when developing a patient's care plan and assist in determining length of stay and outcomes.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

It's important to remember that critical pathways are different from protocols. Critical pathways and the research utilized to develop them do play a large role in protocol development, but they aren't the same thing. Protocols are step-by-step instructions for treatment and standards of care. For example, when caring for a patient with acute stroke, the protocol guides the healthcare provider in early recognition, determination of hemorrhagic versus nonhemorrhagic stroke, and appropriate treatment for each.


A critical pathway is appropriate after the acute phase of stroke care to outline best practice recommendations and highlight vital steps so nothing is forgotten, such as swallow evaluations, physical and occupational therapy evaluations, safety precautions, discharge planning, and patient education. This is where the multidisciplinary team collaborates, using critical pathway guidelines to develop an individualized care plan based on sound research and data to improve safety and outcomes.


Critical pathways can be utilized to educate patients and facilitate access to care. They may also drive nursing and ancillary staff education. These pathways can be used when setting organizational benchmarks-quality outcomes that are measurable and directly influenced by care mapping and best practice guidelines. Process improvement teams use critical pathways to track expected and goal-centered outcomes, as well.


There are some naysayers in healthcare that may refer to this as "cookie cutter medicine," but nothing could be further from the truth. There's always allowance for patients who veer off the path; professional judgment is essential. Critical pathways decrease length of stay, mortality, and hospital costs while providing improved outcomes for patients and increasing patient and staff satisfaction. In addition, they enhance collaboration between services and place all team members, including the patient and family, on the same page for planning and discussion.


REFERENCE Clinical pathways.