Present address: MD, PhD, Member of the Board of Directors, Atrium Medical Center Parkstad, PO Box 4446, 6401 CX Heerlen, the Netherlands.
Systematic review: indicators to evaluate effectiveness of clinical pathways for gastrointestinal surgery
Article first published online: 31 OCT 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Journal of Evaluation in Clinical Practice
Special Issue: Evidence Based Medicine
Volume 14, Issue 5, pages 880–887, October 2008
How to Cite
Lemmens, L., Van Zelm, R., Vanhaecht, K. and Kerkkamp, H. (2008), Systematic review: indicators to evaluate effectiveness of clinical pathways for gastrointestinal surgery. Journal of Evaluation in Clinical Practice, 14: 880–887. doi: 10.1111/j.1365-2753.2008.01079.x
- Issue published online: 31 OCT 2008
- Article first published online: 31 OCT 2008
- Accepted for publication: 19 June 2008
- critical pathways;
- gastrointestinal surgery;
Background A systematic review on clinical pathways for gastrointestinal surgery was performed. The aim was to study indicators that are used to evaluate these clinical pathways and to study which effects of clinical pathways are reported.
Methods A search was performed for the period from January 2000 to November 2006 in MEDLINE, EMBASE and CINAHL. The Leuven Clinical Pathway Compass was used to categorize the indicators reported in literature.
Results Twenty-three studies were selected, of which 16 were controlled studies. The studies assessed most frequently complication rates, re-admissions, mortality and length of stay. More specific indicators like time to start defecation and time to return to enteral feeding were reported as well. None of the studies reported adverse effects in any of the domains of the Clinical Pathway Compass.
Conclusion Clinical pathways for gastrointestinal surgery can enhance efficiency of care without adverse effects on outcome. Specific indicators to evaluate these clinical pathways are time to return to enteral feeding and time to defecate. Furthermore, additional to complication rates, number of re-admissions, mortality and length of stay, indicators such as the number of re-operations, pain scores and intensive care unit admission can be assessed to monitor effectiveness and patient safety of the clinical pathways.