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

Yusuf Subekti1), Atik Nurwahyuni2)


1)Masters Program in Hospital Administration, Faculty of Public Health,

Universitas Indonesia

2)Faculty of Public Health, Universitas Indonesia



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.

Keywords: clinical pathway, length of stay, cost

Correspondence: Yusuf Subekti. Masters Program in Hospital Administration, Faculty of Public Health, Universitas Indonesia, Depok, West Java, 16424. Email: yusufsubekti.md@gmail.com. Mobile: 087875845654.

DOI: https://doi.org/10.26911/the6thicph-FP.04.43

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