title: Systematic review: indicators to evaluate effectiveness of clinical pathways for gastrointestinal surgery.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Perioperative and Emergency Care, University Medical Center Utrecht, Utrecht, The Netherlands. l.lemmens@umcutrecht.nl
authors.forename: Lidwien
authors.initials: L
authors.lastname: Lemmens
authors.forename: Ruben
authors.initials: R
authors.lastname: van Zelm
authors.forename: Kris
authors.initials: K
authors.lastname: Vanhaecht
authors.forename: Hans
authors.initials: H
authors.lastname: Kerkkamp
mesh_terms: D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data; D019091:Critical Pathways / Q000592:standards; D003672:Defecation; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D017558:Elective Surgical Procedures; D004750:Enteral Nutrition; D005069:Evaluation Studies as Topic; D006801:Humans; D007902:Length of Stay; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D010359:Patient Readmission; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D012086:Reoperation; D012107:Research Design; D012449:Safety; D012720:Severity of Illness Index; D013997:Time Factors