Effect of Clinical Pathway on Length of Stay and Hospital Cost: A Systematic Review

Abstract

Bacground: Clinical pathway, also known as care pathway, integrated care pathway, critical pathway, or care map, is the standardization of medical and surgical care process. It can be used to assure the quality of health service, to reduce risk, to control cost, and to increase efficiency of resources use. However, not all cases need clinical pathway. This study aimed to review systematically the effect of clinical pathway on length of stay and hospital cost. Subjects and Method: A systematic review was conducted by searching published articles from 2010 to 2019 from databases, including PubMed, ProQuest, and Cochrane. The inclusion criteria were articles published over the last 10 years, randomization, experiment, cohort, English, full text, and open access. Results: After screening based on inclusion criteria, 13 articles were included in this review. All of the studies investigated inpatient cases, with 10 out of 13 studies performed surgical cases, including of total hip arthroplasty, sphenopalatine artery ligation, pediatric appendictomy, total knee arthroplasty, endocrine operations, hepatic surgery, surgery for uterine fibroids, radical cystectomy, open pulmonary lobectomy and bilobectomy, non-surgical cases of asthma, and neonatal jaundice. All studies measured hospital length of stay. Nine studies looked at the effect on costs. Other effects include resource efficiency, surgical waiting time, complication, and readmission. Conclusion: Clinical Pathway has a positive effect in the reduction of hospital length of stay and costs. It can be carried out for surgical and non-surgical cases with monitoring and evaluation during implementation.

Healthcare Quality Received by Insured Patients in Two Indonesian Regional Public Hospitals

“…Research at Bethesda Hospital Yogyakarta found differences in the cost of acute ischemic stroke treatment after the application of CP where the average cost of treatment in the CP group was IDR 8,212,656.02 while the group without CP was IDR 10,659,617.72. The results of the systematic review showed that 4 out of 6 studies also showed a decrease in the level of 30 days readmissions to 90 days readmissions with the implementation of CP (Iroth et al, 2017; Kaiser et al, 2018; Subekti & Nurwahyuni, 2019; Tanumihardja & Nurwahyuni, 2019). The ICP is a multidisciplinary treatment plan that is structured and details each stage of patient management as well as clinical activity to standardize the care of patients with specific clinical problems.…”