In Chapter 1 a review of the development of the nursing process and several models of nursing were outlined in relation to children’s nursing. In more recent times, healthcare delivery has focused on developing services which are inclusive of patient and health professionals’ views and flexible to ensure evidence-based practice is supported within the finite resources of service provision. Thus, the goals of planning and delivering effective patient-focused care and services which meet the needs of patients has been developed and supported using integrated care pathways. Health delivery systems globally are under increasing pressure to provide effective services to meet the increasing needs of society, whilst working with finite resources in aiming to do so (National Council for the Professional Development of Nursing and Midwifery (NCNM) 2006). Whilst family-centred care has developed within the field of children’s nursing and is utilised alongside the nursing process to organise and aid care delivery, there is an increasing acknowledgement and development of integrated care pathways (ICP). Such developments are purported to support inter-professional working and improve the effectiveness of care delivery and seamless service delivery with organisation and communication across agencies and professionals (NICE 2018). These pathways are increasingly used in care planning and delivering patient care relevant to various conditions and settings, whilst also aiding practitioners in making timely decisions, alongside other health professionals, which are appropriate to the needs of the child and family.

Within this chapter, the origin and elements of ICPs will be discussed and consideration will be given to the development of ICPs for specific patient groups within a clinical environment. The chapter will draw on information from national and international examples when considering their contribution to care delivery. In addition, how these pathways can support the implementation of best practice guidelines and standardised care planning and delivery to children and their families will be included. To illustrate and appreciate the structure and support ICPs offer in delivering care to children and their families, an ICP for the management of bronchiolitis will be utilised in this chapter to outline how these documents can support care planning and delivery.

THE ORIGINS OF INTEGRATED CARE PATHWAYS

Integrated care pathways serve several purposes, including continuous quality improvement, reduction in variation of standards, minimising resource utilisation, and education of healthcare staff (Lee et al. 2021). Such reported activities have contributed to their development and utilisation in current healthcare practice. In attempting to identify the origins and use of these pathways, it is therefore necessary to consider the strengths of these innovations and their contribution to the delivery of healthcare in the twenty-first century. Wakefield (2004) identified the origins of ICPs as being utilised in the USA and Australia from the 1980s, with their introduction in the UK in the 1990s. In responding to the reforms and modernisation of health services in the UK, the need for an integrated approach to healthcare has been reinforced, whereby inter-professional, inter-organisational, and service user collaboration methods are seen as essential components of best practice (Yuliyanti et al. 2020). This translates into putting children and their families at the centre of service planning and delivery alongside multidisciplinary teams. According to Middleton and Roberts (2000) and Whittle and Hewison (2007) this represents the vision for the modern NHS and the means of enhancing high-quality service delivery have been sought through ICPs.

Several authors identify reasons from a governance perspective for the introduction and development of ICPs in the UK; these include demonstrating evidence-based care through the utilisation of best practice guidelines, such as national service framework standards, developing benchmarking standards, and thus addressing the clinical governance agenda (Allen et al. 2009; Campbell et al. 1998; Cunningham et al. 2008; MacLean et al. 2008; Wakefield 2004). Additional strengths of the ICP in care planning and delivery include reducing lengths of hospitalisation, facilitating decision making, and supporting clinical judgement skills. These skills standardise and define the patient’s programme of care and assess the impact on patient outcomes in terms of education and self-management (Lee et al. 2021; MacLean et al. 2008; Whittle & Hewison 2007). Thus, ICPs have become part of contemporary healthcare practice in the UK and are developing globally.

WHAT ARE INTEGRATED CARE PATHWAYS?

Within this chapter the term ICP is utilised; however, it is important to appreciate that within the literature several terms are used to identify these initiatives, including integrated case management, care map, clinical pathways, critical pathways, and integrated care systems. The development and utilisation of these pathways are frequently individually unique to the unit or clinical environment in which they have been developed. They are created for specific purposes as creative solutions to issues in clinical practice and are developed for managing the care of particular patient groups or situations. De Luc (2001) and Yuliyanti et al. (2020) identify the inclusion of all professionals involved in ‘hands on’ care in developing the ICP relevant to the topic of interest, to develop and support the success of the initiative. Careful thought therefore needs to be given to their development and design if changes in practice are to be in the direction intended (Allen et al. 2009). Irrespective of their descriptive title it is important to consider what ICPs are.

Walsh (1998) identifies critical pathways as setting out plans of care to meet the needs of patients with the same medical problem, identifying goals to be achieved and defining outcomes against which progress can be measured, a view supported by Middleton and Roberts (2000). More contemporarily, ICPs are described as multidisciplinary care management tools which map chronologically, activities in healthcare systems which are to be achieved, whilst additionally having a quality improvement function (Allen et al. 2009). Subsequently, having identified agreed goals and outcomes of care provision with other health professions involved in providing care to the individual, it is necessary to create a tool for recording and documenting these aspects which can be used by all involved in the delivery of care for the infant and family. Integrated care pathways have been developed to provide a framework for clinical and treatment decisions regarding care provision which incorporate and support the use of best evidence, by streamlining and standardising care for specific patient groups (NCNM 2006). Baxter et al. (2018) succinctly suggests ICPs as being crucial in delivering care, which is safe, effective, patient-centred, timely, efficient, and equitable in the modern NHS. Indeed, the use of ICPs can be perceived to address the following aspects of professional practice:

• Patient-centred care
  
• High quality and safe-care delivery
  
• Evidence bases for care delivery utilised
  
• Timely delivery of care to meet needs of patient when required
  
• Efficiency through better management and use of services
  
• Equitable service for all patients.

The pathway aims to identify significant factors and progression points along the patient’s journey in relation to a particular disease process or access point to services. Do refer to Box activity 7.1.