Developing a clinical pathway for the care of stomach cancer patients: the ‘‘A. Gemelli’’ experience [Poster walk]

Issue/problem Decision-making in hospitals is evolving from being opinionbased to being evidence-based. Whilst clinical guidelines provide evidence-based recommendations, evidence-based practice needs to address the local structure, systems and time-frames. Clinical pathways are document-based tools that provide a link between the best available evidence and clinical practice. Problem During a meeting with the professional from all ‘A. Gemelli’ teaching hospital units involved in the care of stomach cancer patients as well as primary care representatives, the Clinical Governance Unit presented the project of developing a clinical pathway for the care of stomach cancer patients. Professionals were divided in three groups: a first group analyzed the specific epidemiological context of stomach cancer patients attending the hospital, a second group designed on the basis of evidence and current practice the pathway flowchart in a diagram that shows on vertical axis stages of care and on orizonal axis the places of care and a third group selected quality indicators useful for future audits. After joint debates, the complete clinical pathway was reviewed by the whole group of involved professionals. Results A report including the pathway flowchart of activities articulated in clinical episodes and 28 indicators covering 5 quality dimensions was approved. Multidisciplinary team meetings as well as joint surgeon/medical oncologist examinations were introduced in hospital practice. Case management and cooperation between hospital and primary care were enhanced. The use of hospital resource and the timing between the different care stages as well as patients’ satisfaction resulted improved. Preliminary results show also improvements in clinical outcome measured. Lessons Clinical pathways are an effective instrument to decrease undesired practice variability and improve clinician performance. The early involvement of all professionals in the development of clinical pathways is critical to theirs success. The definition of quality indicators allows to evaluate and monitor implemented clinical pathways. Key messages Clinical pathways providing evidence-based practice can improve quality of care The early involvement of all professionals is a key strategy for clinical pathway development.