Making healthcare run smoother: new insights from updated Cochrane review on clinical pathways

| 19 Sep 2025

When someone is admitted to the hospital with a condition like pneumonia, a stroke, or a fractured hip, their care quickly becomes a team effort. Doctors, nurses, physiotherapists, social workers, and others must work in sync to deliver timely, effective treatment. To help coordinate this complexity, many hospitals turn to clinical pathways -structured, team-based care plans that map out the essential steps for managing specific conditions. These pathways are designed to ensure care is based on the best available care recommendations, and it is delivered in a consistent and efficient manner.

But what is the impact of these roadmaps on patients’ well-being and treatment?

A newly updated systematic review, published in the prestigious Cochrane Library, offers timely insights. Led by Dr. Thomas Rotter at the School of Nursing with 15 colleagues from Canada, Australia, Germany, USA and Netherlands, the review examines how clinical pathways impact professional practice, patient outcomes, hospital length of stay, and hospital costs.

“The earlier version of this review was published in 2010 and has been used for a number of national practice guideline development projects. The version of this Cochrane Review was cited over 1,220 times (as of August 2025), but a lot has changed in healthcare since then,” says Dr. Rotter. “It was important to update the evidence to see how clinical pathways are used today, what’s working, what’s not, and where these pathways can make the most meaningful difference.”

The review draws on evidence from 58 international studies - including 24,841 patients and 2,027 health professionals - covering a wide range of medical conditions and procedures across different hospital settings. Together, these studies provide a rich and comprehensive summary at how clinical pathways are used in real-world healthcare environments, along with some encouraging findings: when clinical pathways are implemented effectively, they reduce complications during hospital stays, shorten the length of stay, and lower healthcare costs. They also improve how healthcare workers follow the recommended ways of providing hospital care, ensuring patient care is based on the best research available.

That said, the review also highlights important limitations. ”Clinical pathways are implemented differently between hospitals and countries, for example because of resources they have available, or the type of healthcare providers they have on staff”, says Dr. Rotter. ”That makes it really tricky to summarize the findings from one study and another, and we’re still not entirely sure how clinical pathways affect outcomes like mortality or hospital readmissions. We need to continue to gather more research data to understand the full impact”

Indeed, that need for stronger evidence is one vital takeaway from the review. Making informed decisions about when and where to implement clinical pathways depends not just on understanding whether they work, but on knowing the conditions under which they work best.

“As healthcare systems face increasing pressure, understanding how to use clinical pathways wisely and effectively is more important than ever,” says Dr. Rotter. “That starts with better evidence and a deeper understanding of context.”

Read the review here [full text access may require a subscription].

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Making healthcare run smoother: new insights from updated Cochrane review on clinical pathways

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