title: Clinical Pathways in surgery: should we introduce them into clinical routine? A review article.
abstract: OBJECTIVE
  In modern health care systems, care providers face ever new challenges with regard to quality and cost of care, as well as to satisfaction and training of staff. Due to the intensiveness of the subject, these challenges are particularly pronounced in surgery. Clinical Pathways, i.e. detailed care plans defining the desired measures to be performed for each treatment period, are thought to be a tool to improve care in surgery with regard to these issues.
  
  
  METHODS
  We performed a literature review to identify studies reporting effects of the implementation of Clinical Pathways into clinical care for the most common surgical interventions. We subdivided findings into Clinical Pathways' effects on economic aspects, quality of care, treatment transparency, staff satisfaction and staff training.
  
  
  RESULTS
  Our search identified 30 studies. Twenty four studies were trials with a before-after design. Four trials had only an intervention group, one trial was a non-randomised controlled trial and one was a randomised controlled trial. Study sizes ranged from six to 1,200 patients. The mean number of patients was 119 in the treatment group and 120 in the comparison group (where existent). Clinical Pathway implementation in surgery has manifold advantages. They improve objective and subjective quality of care, decrease hospitals' costs, increase staff satisfaction and are valuable tools for training. Their effect seems to be most pronounced for high-volume or particularly complex treatments.
  
  
  CONCLUSIONS
  There is substantial evidence that Clinical Pathways lead to various improvements in clinical care in surgery. Their widespread use should therefore be encouraged. However, more research encompassing all facets of Clinical Pathway usage and implying sound methods is strongly required.
authors.affiliation: Department of Surgery, University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany. ulrich.ronellenfitsch@chir.ma.uni-heidelberg.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ronellenfitsch
authors.forename: Eric
authors.initials: E
authors.lastname: Rössner
authors.forename: Jens
authors.initials: J
authors.lastname: Jakob
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Peter
authors.initials: P
authors.lastname: Hohenberger
authors.forename: Matthias
authors.initials: M
authors.lastname: Schwarzbach
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D017046:Cost Savings / Q000592:standards; D019091:Critical Pathways / Q000191:economics / Q000592:standards*; D005858:Germany; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000592:standards; D011785:Quality Assurance, Health Care / Q000191:economics / Q000592:standards; D013514:Surgical Procedures, Operative / Q000191:economics / Q000592:standards*