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

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.