Clinical question

How effective are clinical pathways in improving professional practice, patient outcomes, length of stay and hospital costs?  

Bottom line

Compared with usual care, clinical pathways were associated with a reduction in in-hospital complications (wound infections, bleeding and pneumonia) and with improved documentation. Most studies reported a decreased length of stay and reduction in hospital costs when clinical pathways were implemented. Seven studies comparing clinical pathways as part of a multifaceted intervention with usual care found no evidence of differences between intervention and control groups. The review covered 21 conditions and interventions, ranging from chest pain, stroke and pneumonia to mechanical ventilation and surgery.  

Caveat

Considerable heterogeneity prevented meta-analysis of length of stay and hospital costs. An assessment of whether lower hospital costs contributed to cost shifting to another health sector was not undertaken. Generally, poor reporting prevented the identification of characteristics common to successful clinical pathways.  

Context

Clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimise clinical outcomes while maximising clinical efficiency.  

Cochrane Systematic Review

Rotter T et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Reviews 2010, Issue 3. Article No. CD006632. DOI: 10.1002/ 14651858. CD006632.pub2. This review contains 27 studies involving 11,398 participants in 8 countries.