Table 1.
Examples for use of treatment guidelines and clinical pathways
| References | Study-type/evidence | Patients | Intervention | Endpoints | Results |
|---|---|---|---|---|---|
| Soo Hoo et al. [103] | Observational study (II) | Patients with community-acquired pneumonia (58 patients before intervention, 58 patients after intervention) | Establishment of guidelines for the diagnosis and management of nosocomial pneumonia | Mortality Proportion of patients with guideline-conforming treatment |
Lower mortality rate at 14 days (23 vs 8 %, p = 0.03) Increase in the number of patients treated in conformity with guidelines (46 vs. 81 %, p < 0.01) |
| Botelho-Nevers et al. [104] | Observational study (II) | Patients with infectious endocarditis (173 patients before intervention, 160 patients after intervention) | Establishment of treatment guidelines for management of infectious endocarditis | Mortality Guideline adherence (compound selection, duration of treatment) |
Lower 1 year mortality (18.5–8.2 %, HR 0.41; 95 % CI, 0.21–0.79, p = 0.008) Lower hospital mortality (12.7–4.4 %, p = 0.007) Increase in guideline adherence: compound selection (31.6 % auf 95 %, p < 0.001) Compound selection and duration of treatment (22.7 % auf 61.8 %, p < 0.001) |
| Marrie et al. [93] | Randomised, controlled study (i) | Patients with community-acquired pneumonia in the emergency room of a hospital (nine hospitals with clinical pathway, 10 hospitals without clinical pathway) | Establishment of a clinical pathway for treatment of community-acquired pneumonia in the emergency room of nine hospitals | Mortality Length of hospital stay Duration of treatment Proportion of patients with monotherapy |
No difference in mortality Shorter length of hospital stay by 1.7 days (6.1–4.4 days, p = 0.04) Shorter duration of treatment by 1.7 days (6.3–4.6 days, p = 0.01) Increase in the proportion of patients with monotherapy (27–64 %, p < 0.001) |
| Singh et al. [102] | Randomised, controlled study (I) | Patients with ventilator-associated pneumonia (39 patients treated in accordance with a risk score-based clinical pathway, 42 patients received standard therapy) | Establishment of risk score-based clinical pathway | Mortality Length of hospital stay (ICU) Detection of MDR pathogens Duration of treatment, costs |
No difference in mortality Shorter length of hospital stay (ICU) by 5.3 days (14.7–9.4 days; p = 0.04) Reduced detection of MDR pathogens (38–14 %, p = 0.017 Shorter duration of treatment (9.8–3 days, p = 0.0001) Lower treatment costs (640$–259$, p = 0.0001) |
| Ibrahim et al. [97] | Observational study (II) | Patients with ventilator-associated pneumonia (50 patients before intervention, 52 patients after intervention) | Establishment of a treatment guideline for management of ventilator-associated pneumonia | Mortality Length of hospital stay, antibiotic therapy complying with guidelines, Duration of treatment |
No difference in mortality Increase in the proportion of antimicrobial therapy conforming to guidelines from 48 to 94.2 % (p < 0.001) Shorter duration of treatment from 14.8 days ± 8.1 days to 8.6 ± 5.1 (p < 0.001) |