Clinical Management Protocol

Action Plan             Present Status                Updated on : September, 2011

List of Protocol : Stroke Management   ►Essential Newborn Care   ►Labour Room Specification   ►Management of Acute Coronary Syndrome



Clinical protocol will be developed and implemented to reduce the errors and unjustified variations in clinical practice so as to improve the health care quality based on the best practice as well as to contain the cost. The promotion of clinical protocol aims to provide a quality standard for comparison among different health institutions. Although much effort would be  made in developing clinical guidelines, they have a limited effect on physician’s behavior with various reasons.

Studies have shown that clinicians are often not familiar with written guidelines and also do not apply them appropriately during the actual care process. Implementing guidelines in computer-based decision support systems promises to improve the acceptance and application of guidelines in daily practice in developed countries.

In the link of Clinical protocol. Clinical Pathways were first introduced in the early 1990s in the UK and the USA, and are being increasingly used throughout the developed world. Clinical Pathways are structured, multidisplinary plans of care designed to support the implementation of clinical guidelines and protocols. They are designed to support clinical management, clinical and non-clinical resource management, clinical audit and also financial management. They provide detailed guidance for each stage in the management of a patient (treatments, interventions etc. ....) with a specific condition over a given time period, and include progress and outcomes details.

Clinical Pathways aim to improve, in particular, the continuity and co-ordination of care across different disciplines and sectors.

Care Pathways can be viewed as algorithms in as much as they offer a flow chart format of the decisions to be made and the care to be provided for a given patient or patient group for a given condition in a step-wise sequence.

Clinical Pathways have four main components (Hill, 1994, Hill 1998): a timeline, the categories of care or activities and their interventions, intermediate and long term outcome criteria, and the variance record (to allow deviations to be documented and analyzed).

Clinical Pathways differ from practice guidelines, protocols and algorithms as they are utilized by a multidisciplinary team and have a focus on the quality and co-ordination of care.

The benefit of developing clinical pathway will be

Support the introduction of evidence-based medicine and use of clinical guidelines , support clinical effectiveness, risk management and clinical audit ,  Improve multidisciplinary communication, teamwork and care planning , Can support continuity and co-ordination of care across different clinical disciplines and sectors;


 ·       The detailed outline of the steps to be followed in the treatment of a patient

 ·          Precise and detailed plans for the study of a medical or biomedical problem and/or plans for a regimen of therapy.

 ·          Clinical protocols can be seen as more specific than guidelines, defined in greater detail. Protocols provide "a comprehensive set of rigid criteria outlining the management steps for a single clinical condition or aspects of organization"



·          To describe appropriate care based on the best available scientific documents broad consensus;

·          To reduce inappropriate variation in practice;

·          To provide a more rational basis for referral;

·          To provide a focus for continuing education;

·          To promote efficient use of resources;

·          To Act as focus for quality control, including audit;

·          To highlight shortcomings of existing literature and suggest appropriate future research.

Possible Output:

Clinical protocol will be developed in ten major disciplines with the active participation of relative stakeholder for the next five years


Document Framework

The general requirements of clinical protocol representation emphasize the accuracy and expressiveness of the model. Clinical guidelines contain medical concepts such as diseases, symptoms, signs, procedures and laboratory tests. An in-depth understanding of these concepts is essential for protocol  representation. An expressive protocol representation not only models explicit concepts and logic but also handles uncertainty in patient data and guidelines. But there are always tradeoffs between the complexity and the expressiveness to obtain the appropriate granularity for the guideline representation. Since protocols are not static and they are always subject to changes according to the best evidence, the representation should be flexible enough to accommodate these changes without affecting the parts that remain the same. Furthermore, the clinical management protocol experience local adaptation to make them acceptable to the healthcare providers within a specific clinical setting, which requires the guideline representation to be as general as possible so that they can be shared in different institutions


List of Protocol : Stroke Management     ►Essential Newborn Care    ►Labour Room Specification   ►Management of Acute Coronary Syndrome