The effectiveness of ICPs for adults and children in health care settings: a systematic review

Integrated care pathways The emergence of integrated care pathways (ICPs) in health care has been traced back to the critical path method that was first used by the US navy during World War II.1 Engineering disciplines used a similar tool to plan and control large projects within a specified time frame. 2 First introduced in health care in the 1980s in the US, enthusiasm for ICPs now extends across the world.3,4 They have increasingly been promoted as a means to realise: evidence based practice, clinical governance, continuity of care, patient empowerment, efficiency gains, service re-engineering, role realignment and staff education.5,6 Indeed as Hale7 writing in the UK context, observes, “the purported advantages and benefits of these pathways are prodigious and are such that they could be considered the panacea of all the ills of the health service ” (p.280). Identifying the evidence of effectiveness While ICPs are now being developed and implemented across the international health care arena,3 the evidence to support their use is inconclusive. Reviews focusing on particular client groups are frequently equivocal.8,9,10 However, ICPs can be introduced for a variety o