The "Clinical Pathways" as an improvement strategy in the management of Acute Coronary Syndrome, a narrative review.

Abstract

Introduction: In Colombia, between 2005 and 2017, diseases of the circulatory system were the leading cause of mortality, and for that last year, ischemic heart diseases produced 53.3% (38,618) of deaths within this group of diseases. The increase in cardiovascular diseases is part of an epidemiological transition towards an increasingly costly morbidity profile, threatening the sustainability of the health system. Different clinical management strategies have been implemented worldwide to improve service delivery and contribute to the effectiveness and efficiency of health systems, among which are the so-called “Clinical Pathways”. The objective of this study is to carry out a review of the literature on the results of the Clinical Pathways in the management of Acute Coronary Syndrome.

Method: A narrative review of the literature was carried out in PubMed and other databases.

Results: In this narrative review, 14 articles published between 2013 and 2020 were included. One SR, four RCTs, six quasi-experimental studies (Before-after), two prospective cohort observational, one descriptive observational. The studies demonstrated a positive effect for the improvement of the door-to-balloon opportunity, a reduction in hospital stay and an increase in early discharges, no changes in mortality, complications, or the door-to-needle and door-to-ECG opportunity were evidenced.

Conclusions: The clinical pathways show positive effects in improving the timeliness of care, reducing the length of stay and stimulating early discharges, without detriment to the safety of care or clinical outcomes.