Patient pathways
How coordinated care keeps patients on track
Multidisciplinary pathways link triage, diagnosis, treatment, and follow-up. Clear communication between teams and across facilities supports clinical continuity and patient safety.
What this section covers
Discharge planning, ambulatory networks, supportive oncology, palliative coordination, and the operational points where care most often breaks down.
The continuum
From triage to longitudinal follow-up
Each stage depends on accurate handover. Triage sets priorities, diagnosis frames the plan, treatment is carried out across teams, and post-care monitoring confirms that the plan still fits the patient.
1. Triage: prioritize needs and route patients to the right service. 2. Diagnosis: assemble the findings of several specialties into one shared plan. 3. Treatment execution: coordinate scheduling, medication reconciliation, and transitions between wards. 4. Monitoring: follow symptoms, side effects, and psychosocial needs after discharge.
Support structures
Three elements that hold a pathway together
Inter-hospital communication
Shared records and structured handover notes let a receiving team understand a patient’s history without repeating the same questions.
Nurse navigators
A dedicated navigator is a single point of contact who helps patients and families move between appointments, tests, and services.
Outpatient support networks
Community nurses, primary care teams, and psychological and social services extend support beyond the hospital, where most daily care takes place.