How does the implementation of a patient pathway-based intervention in the acute care of blunt thoracic injury impact on patient outcomes? A systematic review of the literature

TY - JOUR

T1 - How does the implementation of a patient pathway-based intervention in the acute care of blunt thoracic injury impact on patient outcomes?

T2 - A systematic review of the literature

AU - Baker, Edward

AU - Woolley, Alison

AU - Xyrichis, Andreas

AU - Norton, Christine

AU - Hopkins, Philip

AU - Lee, Geraldine

N1 - Copyright © 2020. Published by Elsevier Ltd.

PY - 2020/8

Y1 - 2020/8

N2 - BACKGROUND: Blunt thoracic injury is present in around 15% of all major trauma presentations. To ensure a standardised approach to the management of physical injury, patient pathway-based interventions have been established in many healthcare settings. It currently remains unclear how these complex interventions are implemented and evaluated in the literature. This systematic review aims to identify pathway effectiveness literature and implementation studies in relation to patient pathway-based interventions in blunt thoracic injury care.METHODS: The databases Medline, Embase, Web of Science, CINAHL, WHO Clinical Trials Register and both the GreyLit & OpenGrey databases were searched without restrictions on date or study type. A search strategy was developed including keywords and MeSH terms relating to blunt thoracic injury, patient pathway-based interventions, evaluation and implementation. Due to heterogeneity of intervention pathways, meta-analysis was not possible; analysis was undertaken using an iterative narrative approach.RESULTS: A total of 16 studies met the inclusion criteria and were included in analysis. Pathways were identified covering analgesic management, respiratory care, surgical decision making and reducing risk of complications. Studies evaluating pathways are generally limited by their observational and retrospective design, but results highlight the potential benefits of pathway driven care provision in blunt thoracic injury.CONCLUSIONS: The results demonstrate the complexity of evaluating patient pathway-based interventions in blunt thoracic injury management. It is important that pathways undergo rigorous evaluation, refinement and validation to ensure quality and patient safety. Strong recommendations are precluded as the quality of the pathway evaluation studies are low.

AB - BACKGROUND: Blunt thoracic injury is present in around 15% of all major trauma presentations. To ensure a standardised approach to the management of physical injury, patient pathway-based interventions have been established in many healthcare settings. It currently remains unclear how these complex interventions are implemented and evaluated in the literature. This systematic review aims to identify pathway effectiveness literature and implementation studies in relation to patient pathway-based interventions in blunt thoracic injury care.METHODS: The databases Medline, Embase, Web of Science, CINAHL, WHO Clinical Trials Register and both the GreyLit & OpenGrey databases were searched without restrictions on date or study type. A search strategy was developed including keywords and MeSH terms relating to blunt thoracic injury, patient pathway-based interventions, evaluation and implementation. Due to heterogeneity of intervention pathways, meta-analysis was not possible; analysis was undertaken using an iterative narrative approach.RESULTS: A total of 16 studies met the inclusion criteria and were included in analysis. Pathways were identified covering analgesic management, respiratory care, surgical decision making and reducing risk of complications. Studies evaluating pathways are generally limited by their observational and retrospective design, but results highlight the potential benefits of pathway driven care provision in blunt thoracic injury.CONCLUSIONS: The results demonstrate the complexity of evaluating patient pathway-based interventions in blunt thoracic injury management. It is important that pathways undergo rigorous evaluation, refinement and validation to ensure quality and patient safety. Strong recommendations are precluded as the quality of the pathway evaluation studies are low.

KW - Analgesia

KW - Chest trauma

KW - Hospitalisation

KW - Implementation science

KW - Injury

KW - Pathway development

KW - Pathway evaluation

KW - Patient pathway

KW - Rib fractures

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=85087019059&partnerID=8YFLogxK

U2 - 10.1016/j.injury.2020.06.002

DO - 10.1016/j.injury.2020.06.002

M3 - Review article

C2 - 32576379

SN - 0020-1383

VL - 51

SP - 1733

EP - 1743

JO - Injury

JF - Injury

IS - 8

ER -