Interventions:
The intervention was reported in detail and was compared with the usual practice before its implementation.
Effectiveness/benefits:
Observational, before-and-after, studies have some limitations, such as bias and confounding, and these were not discussed nor addressed by the authors. There was no discussion on the comparability of patients at baseline and no demographic and baseline characteristics were presented. The sample was selected using predefined criteria, which were reported, but this does not mean that the groups were comparable.
Costs:
The economic viewpoint was not explicitly reported, but appears to have been that of the institution providing the intervention. The required components of an economic evaluation (a comparison of the costs and effects of two interventions) were presented, but this was not the aim of the analysis. The primary aim seems to have been to demonstrate the benefit of the clinical pathway to the department and the costing was superficial and was used as an indication of effectiveness. Only the mean costs were reported, with no breakdown of resources nor unit costs.
Analysis and results:
No summary measure was derived and the issue of uncertainty was not addressed. The clinical pathway reduced the variability in care, but the lack of reporting of the clinical comparability of the two groups and of the cost data means that it is not clear that there was a reduction in the costs and hospital stay. There were a number of limitations, and these were not discussed by the authors.
Concluding remarks:
: There were several limitations to the study validity and the authors’ conclusions should be considered with caution.