Do clinical pathways really improve clinical performance in mental health settings?
OBJECTIVE
Royal Brisbane and Women's Hospital (RBWH) Mental Health developed and trialled two clinical pathways on psychosis and depression between 2001 and 2003 with the aim of improving a range of clinical and financial parameters. There was a strong commitment from senior management, appropriate resources were allocated and there was adequate staff support. Following a 6-month trial, the pathways were reworked extensively and combined into an acute inpatient pathway. From October 2003 to 2004, we trialled the acute inpatient clinical pathway, and monitored clinical and financial parameters.


CONCLUSIONS
Over this 12-month period, the acute inpatient clinical pathway failed to demonstrate improvement on a range of clinical and financial parameters and its use was ceased. This trial lends support to the view that the complexity, individuality and variability of mental disorders means that clinical pathways are not beneficial in mental health settings.
Emmerson
Brett
B
RBWH Mental Health, Discipline of Psychiatry, University of Queensland, Brisbane, QLD, Australia. brett_emmerson@health.qld.gov.au
Frost
Aaron
A
Fawcett
Lisa
L
Ballantyne
Emma
E
Ward
Warren
W
Catts
Stan
S
D000208:Acute Disease; D001315:Australia; D019091:Critical Pathways; D003866:Depressive Disorder / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D004282:Documentation / Q000379:methods; D006282:Health Personnel; D006302:Health Services Research; D006778:Hospitals, Psychiatric / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008605:Mental Health Services / Q000191:economics / Q000592:standards*; D011618:Psychotic Disorders / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome