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Why use clinical pathways rather than practice guidelines?

¹Maricopa Medical Center, Phoenix, Arizona, USA.

American Journal of Surgery

|December 31, 1997

Summary

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Clinical pathways, developed by surgical congresses, reduce hospital stays and costs, improving patient satisfaction. Practice guidelines show variable effectiveness, with few having documented proof of efficacy.

Area of Science:

Healthcare Management
Surgical Practice
Quality Improvement

Background:

Managed care and governmental pressures drive the creation of practice guidelines and clinical pathways.
Clinical pathways integrate all healthcare system segments, potentially benefiting patients and providers.

Purpose of the Study:

To provide a historical narrative on the development of clinical pathways by the Southwestern Surgical Congress (SWSC) and Southeastern Surgical Congress (SESC).
To discuss the motivations, benefits, and hazards associated with both clinical pathways and practice guidelines.

Main Methods:

Historical narrative review of clinical pathway development.
Discussion of motivations, benefits, and hazards of practice guidelines and clinical pathways.

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Main Results:

Clinical pathways demonstrate reductions in length of stay (LOS), complications, and costs, alongside increased patient satisfaction.
Practice guidelines from some specialties indicate improved quality of care compared to non-specialists.
Many practice guidelines lack documented studies proving their effectiveness, often based on 'best practice' standards.

Conclusions:

The SWSC and SESC have developed eleven clinical pathways, currently undergoing revision and efficacy studies.
These pathways will be disseminated via The American Surgeon and the SWSC website for public review.
The congresses aim to publish pathway efficacy data in 1998, focusing on LOS and charges for diagnostic-related groups.