Clinical Pathway -- to follow or not to follow

Background and Objective: Clinical Pathways are expected to make health care delivery more efficient and effective. Yet we have very little research on how Clinical Pathways are followed. This study assesses the functioning of a Clinical Pahway for elderly people in a Finnish case. At the same time it documents the hardships of getting information on the patient flows in a Clinical Pathway. Study Design/Materials and Methods: The data on all patients aged 75 years or more who had visited the emergency unit of the city hospital in 2006–2008 was collected. The study sample comprised 24,195 admissions. The flow of patients after the first care at the emergency unit was analysed, collecting data from various scattered sources. Results: The results show that the planned Patient Pathways seem not to be followed always. Yearly about 17% of the patients were referred to the university hospital, the more expensive care, but about 74% of these referrals did not follow the agreed procedure. The excess costs of referring patients to a non-standard, more expensive Clinical Pathway were 2,57 Million Euros over a period of three years for the studied population of 24,195 admissions, also averaging 106 Euros per admission. Conclusion: Clinical Pathways were not followed in the case as planned and expected. Reasons for this should be better understood and studied in more depth. In addition, follow-up information of Clinical Pathway flows is often hard to collect because of fragmented information systems, that are not designed to document patient flows in Clinical Pathways.