A tale of three pathways: the experience of RBWH Mental Health.
OBJECTIVE
Australian research has identified that there are significant variations between service providers in terms of clinical management of patients with comparable presenting problems. Internal audits within the facility at Royal Brisbane and Women's Hospital revealed that these variations occurred between wards, treating teams and psychiatric consultants. Given the increasing emphasis on evidence-based practice, it was decided that the literature should be reviewed to determine what the standard of care should be. The paper then examines how clinical pathways for psychosis and for depression were developed and how they eventually evolved into an acute inpatient pathway. It identifies the framework used and examines important aspects relating to the adaptation of these frameworks to mental health issues. The process for the development and implementation of the clinical pathway is discussed. Recommendations for their future use in a mental health setting are also presented.


CONCLUSIONS
Mental Health care is complex. For this reason, mental health clinical pathways have to remain flexible and innovative. With the present project, it was found that the pathways were not suited for specific diagnoses so that they evolved into a single acute inpatient pathway.
Emmerson
Brett
B
RBWH Mental Health, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia. Brett_Emmerson@health.qld.gov.au
Fawcett
Lisa
L
Frost
Aaron
A
Lacey
Maree
M
Todd
Cathy
C
Powell
Jacinta
J
D001315:Australia; D019091:Critical Pathways; D003866:Depressive Disorder / Q000628:therapy; D006801:Humans; D008485:Medical Audit; D001523:Mental Disorders / Q000628:therapy*; D010348:Patient Care Team / Q000592:standards; D011567:Psychiatric Department, Hospital / Q000592:standards*; D011618:Psychotic Disorders / Q000628:therapy; D014932:Women's Health Services / Q000592:standards*