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Clinical Caremap Development: How Can Caremaps Standardise Care When They Are Not Standardised?

“…As caremaps evolved into graphical representations we begin to find contemporary caremaps presented as a separate but complementary component to the clinical pathway or clinical practice guideline (Dickinson et al, 2000;Saint-Jacques et al, 2005). More recent caremaps are linked to or provide a graphical flow representation for a clinical practice guideline (CPG) or surgical event (Chan, et al, 2005), (Houltram & Scanlan, 2004), (Royall, et al, 2014). While retaining the purpose and flow, many of those seen today annexed to CPGs have even dropped the title (Reading, et al, 2015), (RWH, 2010), (TCHaW, 2010), (Thompson, et al, 2013).…”

“…As described in Table 1, caremaps have evolved from wordy texts (Goode & Blegen, 1993), (Gordon, 1996), (Holocek & Sellards, 1997), (Matula & Shollenberger, 1999), (Bumgarner & Evans, 1999), (Philie, 2001) to illustrative graphs (Chu & Cesnik, 1998), (Panzarasa, et al, 2002), (Houltram & Scanlan, 2004), (Royall, et al, 2014), (Li, et al, 2014), (Michelson, et al, 2018). Most contemporary caremaps present either as monochromatic, i.e.…”

“…In some cases, activities that lead to different mutually exclusive pathways are presented by a diamond (Panzarasa, et al, 2002), (Ye, et al, 2009), (van de Klundert, et al, 2010), (Li, et al, 2014). The flow from one activity to another is illustrated with arrows (Panzarasa, et al, 2002), (Houltram & Scanlan, 2004), (Chan, et al, 2005), (Milne, et al, 2013), or simple lines (Dickinson, et al, 2000), (Li, et al, 2014). The literature lacks a clear description as to whether a caremap should have an entry and an exit point.…”

“…Caremaps are intended to standardise health services by organising and sequencing care delivery, ensuring a standard of care and timely outcomes using an appropriate level of resources (Blegen, et al, 1995), (Bumgarner & Evans, 1999), (Hampton, 1993), (Marr & Reid, 1992). The caremap can also help track variance in clinical practice, as it provides a simple and effective visual method for identifying when treatment or patient outcomes have deviated from the routine evidence-based pathway (Marr & Reid, 1992), (Houltram & Scanlan, 2004).…”

“…Nursing caremaps from the early 1990's contained considerably more text than their contemporary counterparts, and were presented as the sum of two components: (1) identifying patient problems and necessary outcomes within a timeframe which are (2) broken down and described dayby-day as tasks on a critical path, (Marr & Reid, 1992), (Ogilvie-Harris, et al, 1993). Later approaches presented three components: (1) the flow chart diagram; (2) the transitional text-based care map of activities broken down day-to-day, and; (3) the evidence base relied upon in their construction (Houltram & Scanlan, 2004). It is these approaches which may have resulted in the terminology confusion that persists to today.…”