208 Lippincott’s Case Management September/October 2001 Grimshaw and Russell 1 conducted a rigorous systematic review of the impact of tools to guide evi- dence-based practice. They studied 59 published evaluations of clinical guidelines that met defined cri- teria for scientific rigor and concluded that all but 4 of the 59 published evaluations detected significant change in the process of care. However, the size of the measured improvement varied substantially. Nine of 11 papers investigated in this review reported that clinical guidelines do improve clinical outcomes. Importantly, Grimshaw and Russell’s review identi- fied clinical guidelines that were rigorously imple- mented, evaluated, and published. 1 Therefore, the positive outcomes identified are only relevant to rig- orously implemented, evaluated, and published clini- cal guidelines and represent a standard of quality in clinical guidelines development that delivers im- proved care. The rigor of the clinical guidelines in- Lippincott’s Case Management Vol. 6, No. 5, 208–219 © 2001, Lippincott Williams & Wilkins, Inc. http://www.nursingcenter.com C linical pathways (also known as care maps, criti- cal paths, case maps, and care paths) and clini- cal guidelines have been strongly promoted as a means of implementing evidenced-based practice. Ample evidence supports the assertion that when clinical pathways and clinical guidelines are used to guide care delivery that there are benefits to all par- ties involved. 1–7 However, evidence suggests health professionals’ compliance with clinical pathways, and other tools of evidence-based practice such as clinical guidelines, is low. This article describes a study that measures the documented compliance with a clinical pathway designed for an acute myocardial infarction (AMI) in a major Australian regional hospital. LITERATURE REVIEW Improved Client Outcomes There is strong evidence that clinical pathways and clinical guidelines developed and implemented as tools promoting evidence-based practice have bene- fits related to quality of health service delivery. Evidence-based Practice Needs Evidence-based Implementation Leigh Kinsman, RN, BHSc, MHSc; Erica L. James, PhD Clinical pathways have been designed to provide an effective interface between evidence and practice in healthcare. Strong evidence supports the assertion that when clinical pathways are utilized they improve outcomes. However, published evidence measuring the uptake of clinical pathways by health professionals remains sparse. This article presents a study evaluating the degree of documented compliance with the clinical pathway chart used for patients diagnosed with an acute myocardial infarction (AMI) in a major Australian regional hospital. The relationships between compliance and demographic and illness were also examined. Data were collected from 124 records with the result that the level of documented compliance was 16.5%. Clients with private health insurance had significantly higher documented compliance with the clinical pathway than those with no private health insurance. There were also significant variations in documented compliance according to the type of AMI recorded. Recommendations to improve compliance with clinical pathways are included along with recommendations for future research. CEU Address correspondence and reprint requests to: Leigh Kinsman, Lecturer in Nursing, School of Health and Environment, LaTrobe University, Bendigo, P.O. Box 199, Bendigo, Victoria, Australia 3552 (e-mail: l.kinsman@ bendigo.latrobe.edu.au).