Clinical Pathway

In my recent cardiopulmonary placement, I spent most of my time on the cardiothoracic ward. Patients included heart surgery patient, lung surgery and general medical patients.
For patients who underwent heart surgery, there is a pathway of their treatment, for all aspects of their medical needs and also allied health treatment. For a typical physiotherapy treatment, treatment initially includes chest review and progress mobility as appropriate. A normal recovery would indicate patient is able to sit out of bed and stand on Day1, ambulate on Day2 – Day 4 and a stair test (2 flights of stairs) as a final discharge test on Day 5. For respiratory part of recovery, treatment included SMIs or ACBT for patients with productive coughs. For most of my heart surgery patients, they have followed this recovery process. It is a lot easier with a pathway, it is a lot easier to progress their mobility. On the other hand, it is also a lot easier to just do a routine treatment, instead of targeting their particular impairment/problems, which I was sort of doing in the first two weeks of my placement.
However my clinical tutor and supervisor reminded me that though there is a pathway, we still need to identify their individual physiotherapy problems, identify their previous functional level and know especially what is normal for them and set a goal for them to discharge. This way is particularly more helpful when a patient is off pathway due to delay in their recovery process. There were a few patients who were delayed due to their medical stability and as well as pre-admission status. The pathway needs to be altered to suit their needs. For example, if they were unable to perform the stair test, and have minimum exposure to stairs, then they would still be fine to go home if they were able to do a few steps in the physio gym. There were a few patients of mine actually had to perform the steps in the gym on after Day 6 instead of the full stair test. Moreover, prioritizing their problems is important to maximise their recovery. Some of my patients were limited in ambulation. However it can be contributed by a few factors such as shortness of breath due to reduced lung volume, impair gas exchange etc, due to muscular wasting as they were delayed and deconditioned, or pain which can be a big factor if it’s poorly managed. Furthermore, patient can perform better than the pathway. Some of my patients even walked on Day1.
I have previously been to an orthopaedic inpatient setting where they also uses the pathway. I have realized that the pathway is there to assist the treatment, however we do need to see beyond the pathway and set individual plan and tailor treatment to individual patients. Thus not limiting patient’s recovery to the pathway as well as promoting fastest recovery to patient with delayed recovery.