Impact of Clinical Pathway Implementation on Length of Stay in Ischemic Stroke Patients
Telly Purnamasari1*, Rizaldy Pinzon2, Ratna Djuwita Hatma3, Ajeng Tias Endarti4

1)National Research and Innovation Agency, Cibinong, Bogor, 16911, Indonesia
*tellypramadi[at]gmail.com
2)Bethesda Hospital, Gondokusuman, DI Yogyakarta, 55224, Indonesia
3)Faculty of Public Health, Universitas Indonesia, Depok, West Java 16424, Indonesia
4(Faculty of Public Health, Universitas MH Thamrin, Central Jakarta, 10440, Indonesia

Abstract

Length of stay (LOS) is an important indicator of hospital service quality. Prolonged LOS is often associated with higher treatment costs, increased risk of nosocomial infections, and decreased quality of care. A clinical pathway (CP) is a multidisciplinary guideline designed to standardize clinical management across professions while improving efficiency. In Indonesia, evidence regarding the impact of CP remains limited and previous findings are inconsistent. This study aimed to evaluate the effect of CP on LOS among patients with ischemic stroke. A retrospective cohort was conducted using data from three hospitals that have maintained a Stroke Registry since 2012, with data collected between November 2015-September 2016. A total of 651 medical records of ischemic stroke patients were analyzed, consisting of 462 with CP and 189 without CP. The median LOS was determined using Receiver Operating Characteristic (ROC) analysis and categorized as short (&#8804-8 days) or long (>8 days). Multivariate Cox regression was applied to assess the effect of CP on LOS while adjusting for potential confounders including age, sex, comorbidities, clinical factors, service processes, and management support. The results showed that the implementation of CP significantly reduced the risk of long LOS (>8 days) by 53% after controlling for disease severity, management support, and service processes (HR: 0.47- 95% CI: 0.24-0.93- p=0.020). These findings highlight the importance of CP as a hospital management strategy. Consistent implementation, coupled with routine monitoring and evaluation, is recommended to enhance care quality and efficiency.

Keywords: clinical pathway, length of stay, ischemic stroke, hospital service quality

Topic: Other

Plain Format | Corresponding Author (Telly Purnamasari)

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