The effectiveness of clinical pathways in inpatient settings - an umbrella review

The aim of this research is to summarize the effectiveness of clinical pathways in inpatient settings in industrialized countries to gain implications for hospital management or identify further research needs.

Systematic literature reviews and meta-analyses published in English from 2010 to August 30, 2023, investigating the effectiveness of clinical inpatient pathways are identified, summarized, and synthesized. PubMed, Cochrane Library, and MEDLINE databases were searched.

The search identified a total of ten systematic reviews, of which seven also conducted meta-analyses. The results show substantial heterogeneity in the data. In total, data from 140 primary studies are included. The parameters that were most frequently examined are complication rates, impact on length of stay, readmission rates, mortality, documentation quality, and hospital and care costs.

A positive impact of clinical pathways, including a reduced risk of complications, reduced length of stay, and a better documentation quality, can be summarized. However, the definition of the concept of clinical pathways already differs and the outcomes that were examined also differ in their definition and measurement. The results of this research on clinical pathways are not sufficient for transfer to the current situation. The results show an added value for patients, staff, and relatives, particularly for clinical pathways that involve frequent illnesses, are cost-intensive, and require a lot of communication between different professionals. Furthermore, it can be concluded that further research with randomized controlled trials is necessary to investigate the effectiveness of clinical pathways.