Clinical Care Pathways in Neurosurgery in the Canadian Context

Abstract

Background Clinical Care Pathways (CCPs) are a form of organized care processes and mutual decision making regarding select patient groups in a specific context. Their aim is to enhance care quality, patient satisfaction, and outcomes while optimizing safety and resource utilization. CCPs are poorly characterized in the Canadian context, with a few examples of successful programs but no organizational framework. Aims & Methods Through an interview series and qualitative descriptive content analysis, this thesis attempts to discern neurosurgeon perspectives on CCPs, important content and processes, and barriers to CCP development. Through a retrospective case control study, for operative patients at one Canadian center, a second project describes characteristics of entry to neurosurgical care for the purpose of understanding system inputs and subsequent CCP development. Results Interviewed neurosurgeons describe a positive sentiment toward CCPs overall, with nuanced understanding coalescing between numerous perspectives. Respondents described CCPs heterogeneously, but overall recognized their structure. Current care barriers were identified. Numerous existing informal or partial CCPs were discussed. CCPs are noted to have specific essential elements in their design. Retrospective review of care entry from July through December 2022 analyzed 654 operative cases and 2135 regional urgent consult requests. This analysis revealed differences in care entry dependent on disease entity, referral characteristics, patient characteristics, and patient acuity. Conclusions Design and development of CCPs is an emerging practice in the Canadian neurosurgical context. Numerous institutions and groups are presently developing their local CCPs. This analysis serves as a preliminary structure of CCP design, with an example retrospective analysis of the care entry component at a local institution.