Clinical Pathways as a Tool for Process Management in Kidney Transplantation

The standardisation of perioperative processes has a crucial influence on quality of care in kidney transplantation. Clinical Pathways are an attractive tool for process management. They are structured, interdisciplinary care plans which stipulate in detail all diagnostic and therapeutic measures to be conducted throughout the treatment of a patient. The evidence regarding quality effects of Clinical Pathways in kidney transplantation is however sparse. There are only four studies, all of a low evidence level. Studies from the US showed a reduction of length of stay, decreasing hospital costs, and in one case also a decrease in morbidity. The single German study showed that process quality increased following the implementation of a Clinical Pathway. Morbidity, mortality, and long-term graft function did not change significantly, but the power of the study was also rather low. In the light of this evidence, it becomes obvious that large randomised trials on quality effects of Clinical Pathways in kidney transplantation should be conducted before their use in clinical routine can be unrestrictedly promoted.