title: Use of an integrated care pathway: a third round audit of the management of shoulder pain in neurological conditions.
abstract: OBJECTIVE
  To complete a third round audit of management of shoulder pain using an integrated care pathway, to evaluate pro forma documentation and to determine outcome.
  
  
  METHODS
  Thirty-four patients with upper limb paresis admitted to a rehabilitation unit during a 22-month period had shoulder pain and were included in the integrated care pathway.
  
  
  METHODS
  Retrospective review of pro forma documentation against pre-determined standards.
  
  
  RESULTS
  Compared with the second round audit, performance against 5 out of 9 standards for initial assessment and documentation had improved, and ranged from 56% to 94%. Achievement of 9 further standards relating to continued management ranged from 44% to 97%. Variance was not always well recorded. Shoulder pain resolved or improved in 18/34 (53%) of patients.
  
  
  CONCLUSIONS
  Introducing the pro forma improved standards of documentation and demonstrated a positive outcome in over half the patients. Some problems with developing and maintaining integrated care pathways in the context of rehabilitation are discussed.
authors.affiliation: Regional Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK. dmj1@soton.ac.uk
authors.forename: Diana
authors.initials: D
authors.lastname: Jackson
authors.forename: Lynne
authors.initials: L
authors.lastname: Turner-Stokes
authors.forename: Heather
authors.initials: H
authors.lastname: Williams
authors.forename: Rana
authors.initials: R
authors.lastname: Das-Gupta
mesh_terms: D000328:Adult; D019091:Critical Pathways / Q000458:organization & administration*; D004282:Documentation; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000150:complications* / Q000534:rehabilitation; D016730:Program Development; D012047:Rehabilitation Centers / Q000458:organization & administration; D012189:Retrospective Studies; D020069:Shoulder Pain / Q000209:etiology / Q000534:rehabilitation*