LIFE at SGH Campus | Jan/Feb 2013
focus
Physiotherapist Ong Peck Hoon uses data from CCPs for her research.
Brought to you by Quality Management
About Coordinated Clinical Pathways (CCP)
The case for consistent, coordinated care
The multidisciplinary team at Ward 74 uses CCP as an integral part of its management of stroke patients.
What is a CCP?
Why do we use CCPs?
To improve the coordination of care for patients who suffer from congestive cardiac failure, a team comprising of doctors from SGH and the National Heart Centre Singapore (NHCS), as well as nurses and allied health professionals, have come together to revise the Coordinated Clinical Pathway (CCP) used to care for this group of patients.
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aunched in October 2012, this CCP serves as a guide in coordinating care from inpatient to outpatient settings and including right-siting of patients from primary care to tertiary care. As congestive cardiac failure patients are admitted to different wards, this is the first CCP in SGH to be implemented across five wards – 73, 63C, 53C, 54D and 74. This is also the first CCP to use a checklist format, which reduced its length from 32 to three pages. “Our nurses find the checklist format easy to understand and simple to use – a good reference guide for the care team,” said Christine Gan Siew Gek, Senior Nurse Manager, Ward 63C.
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“We decided to revise this CCP as congestive cardiac failure patients have complex care needs and require coordinated multi-disciplinary care to improve clinical outcomes. This is particularly relevant following the re-organisation of the delivery of internal medicine service to our patients,” said A/Prof Chow Wan Cheng, Chairman of the Division of Medicine, and former Head of the Department of Internal Medicine. “We have also sought the input from our colleague in NHCS, Dr David Sim, who has a special interest in congestive cardiac failure. The review of this CCP, with inputs from an expert in this subspecialty field, will ensure consistency and
A/Prof Yue Wai Mun finds CCPs helpful in training junior staff.
optimal standard of care within the Department of Internal Medicine (DIM) for all patients with the same condition. It also allows us to establish a common understanding with our NHCS colleagues for the referral of patients who will benefit from augmented subspecialty care. This helps to improve the effectiveness and efficiency of care delivery without compromising patients’ clinical outcome." “We look forward to the development of more CCPs by the Department of Internal Medicine, in collaboration with other subspecialty departments, for other medical conditions that are commonly seen in the department,” said A/Prof Chow.
Using CCPs in the care of patients ensures that they receive consistent and coordinated care for common clinical conditions. This will lead to better clinical outcomes. It helps doctors in their work by reminding them what needs to be done and what to look out for. In a teaching institution like SGH, where junior staff are rotated to different departments all the time, it is helpful in their training too.” — A/PROF YUE WAI MUN, Senior Consultant, Department of Orthopaedic Surgery
Some of our registered nurses will be taking on an expanded role to perform complex care on patients in the urology, colorectal, general surgery and orthopaedic departments. Known as Resident Nurses, they will play a key role in the development and utilisation of the specialtyspecific CCPs within their disciplines. The CCPs will be the main tools used in the management and delivery of evidence-based quality healthcare in an organised and effective manner.” — DR TRACY CAROL AYRE, Director, Nursing
Patient care without a CCP is like an orchestra missing a conductor: The players can still play the music, but the outcome may lack synchrony. Information collected from the CCPs is also valuable. We have used data from the knee replacement CCP to improve on our patient care and for research purposes. This has led to one published paper with two under review.”
CCPs are structured, multi-disciplinary plans of care designed to support the implementation of clinical guidelines and protocols for specific clinical conditions. CCPs come in different designs, such as a complete document of exact items to be performed including the clerking sheets, a flowchart as a reminder of what needs to be done or a checklist. Variance forms are included in many of our CCPs to collect data for measuring clinical outcomes and performance. This provides a platform for care practice review to improve the quality of care delivered.
CCPs in SGH CCPs were initiated in SGH in 1997 and we have 33 CCPs to date. CCPs were first introduced in the early 1990s in the UK and the USA. Since then, CCPs have been used not just in the developed world, but in developing countries like China. In fact, senior management from a number of hospitals in China and Hong Kong have visited Quality Management to learn more about SGH’s experience in developing CCPs. Our hospital-wide CCP utilisation rate is 93.1% from January 2009 to June 2012. Notably, the stroke CCP and breast reconstruction CCP have achieved impressive utilisation rates of 99.3% and 100% in the same time period.
— ONG PECK HOON, Principal Physiotherapist, Department of Physiotherapy.
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