Mudzingwa Innocent Tawanda, Prior Sarah Jane, Griffin Phoebe, Tavender Emma, Tran Viet
Tasmanian School of Medicine, University of Tasmania, Hobart, TAS, Australia.
Tasmanian School of Medicine, University of Tasmania, Burnie, TAS, Australia.
Health Serv Insights. 2025 May 7;18:11786329251328527. doi: 10.1177/11786329251328527. eCollection 2025.
Clinical pathways (CPWs) are evidence-based, standardised, clinical management plans that are designed to deliver a sequence of clinical interventions to improve the efficiency and effectiveness of healthcare. The aim of this study was to identify and summarise the current available evidence on the use of CPWs in emergency departments (EDs).
A literature search was conducted in Scopus, Embase, Emcare, and PubMed academic databases. The search strategy was guided by Arksey and O'Malley's framework and results reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews Checklist. Studies were included if they reported empirical data either qualitatively or quantitatively, studied the use of CPW practices, and reported on the use of at least one CPW activity.
Sixty-four articles were eligible for the scoping review. Variation and quality of treatment, resource utilisation and time to treatment were identified as the three main patient and organisational outcomes from the use of CPWs. Three main categories of barriers to use were identified: Organisational environment factors, Healthcare professional-related factors, and CPW operational issues.
CPW implementation has wide positive patient and organisational outcomes in the ED. Whilst no single strategy would result in implementing CPWs in the ED settings successfully, broad engagement with clinicians of all disciplines who use the pathways and involvement of multidisciplinary teams in implementation is vital to increase visibility of the CPW.
临床路径（CPW）是基于证据的标准化临床管理计划，旨在提供一系列临床干预措施，以提高医疗保健的效率和效果。本研究的目的是识别并总结急诊科（ED）使用临床路径的现有证据。
在Scopus、Embase、Emcare和PubMed学术数据库中进行文献检索。检索策略以阿克西和奥马利的框架为指导，并根据系统评价和Meta分析扩展的范围审查清单的首选报告项目报告结果。如果研究定性或定量报告了实证数据、研究了临床路径实践的使用情况并报告了至少一项临床路径活动的使用情况，则纳入研究。
64篇文章符合范围审查的条件。治疗的差异和质量、资源利用和治疗时间被确定为使用临床路径的三个主要患者和组织结果。确定了使用临床路径存在的三大类障碍：组织环境因素、医疗保健专业人员相关因素和临床路径操作问题。
临床路径的实施在急诊科对患者和组织产生广泛的积极结果。虽然没有单一策略能成功在急诊科实施临床路径，但让使用这些路径的所有学科的临床医生广泛参与以及多学科团队参与实施对于提高临床路径的可见性至关重要。
