Analysis of Cesarean Section Clinical Pathway Compliance at a Private Hospital in Yogyakarta

Beta Haninditya(1*), Tri Murti Andayani(2), Nanang Munif Yasin(3)

(1) Graduate Program of Pharmacy, Faculty of Pharmacy, Universitas Gadjah Mada
(2) Faculty of Pharmacy, Universitas Gadjah Mada
(3) Faculty of Pharmacy, Universitas Gadjah Mada
(*) Corresponding Author


This study aims to analyze the relationship between the compliance with the implementation of clinical pathways to therapeutic outcomes (ILO events, length of stay, pain intensity) and the total real cost of cesarean section patients. The study was conducted at a type C private hospital in Yogyakarta. This study is a non-experimental analytical study (observational analytic) with a cross sectional design using a retrospective data collection method and analyzed using Chi square test and non parametric regression test. Descriptive analysis for compliance with the implementation of clinical pathways was carried out by assessing the compliance of each care point contained in the clinical pathway section of the cesarean consisting of 12 points of care and will be grouped into two categories namely low compliance category with the average compliance value for clinical pathway <85% and good compliance with the average compliance value for clinical pathway ≥85%. Descriptions of adherence to the implementation of clinical pathway cesarean section each patient showed that as many as 686 patients (98%) had a good average compliance score and 14 patients (2%) had a low average compliance score. Outcome description 700 patients with cesarean section were found 1 patient experienced ILO, LOS according to clinical pathway (≤3 days) as many as 620 patients and 700 patients with pain scale ≤3. The results of the analysis of the relationship between the compliance and the implementation of the clinical pathway to the outcome of therapy (ILO events, length of stay, and pain intensity) showed the existence of a compliance relationship to the implementation of the clinical pathway with a value of p<0.05. The analysis of the relationship between the compliance to the implementation of the clinical pathway and the total real costs shows the relationship between the compliance   with   the   implementation   of  the  caesarean  section  clinical  pathway  at  a  type  C  private hospitals in Yogyakarta with the total real costs with p value of 0,000 and r value of 0.014.


clinical pathway; seksio sesarea; biaya riil; cesarean section; real cost

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1. Kemenkes. Peraturan Menteri Kesehatan Nomor 69. tentang Standar Tarif Pelayanan Kesehatan Tingkat Pertama dan Fasilitas Kesehatan Tingkat Lanjutan dalam Penyelenggaraan Program Jaminan Kesehatan Nasional.2013. Accessed December 26, 2018.

2. Nasution CR. Peran Rumah Sakit Swasta Sebagai Fasilitas Kesehatan Rujukan Dalam Pelayanan Kesehatan Di ERA Jaminan Kesehatan Nasional. Disampaikan Pada Pertemuan Sosialisasi Peraturan Perundang-undangan Bidang Kefarmasian Dan Alat Kesehatan: 2014. Accessed December 25, 2018.

3. Rotter T, Kinsman L, James EL et al., Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Cochrane Database of Systematic Reviews. 2010;(3).

4. Gibbons L, Belizan JM, Lauer JA, Betran AP, Marialdi M, Althabe F. The Global Numbers And Cost Of Additionally Needed And Unnecessary Caesarean Sections Performed Per Year: Overuse As A Barrier To Universal Coverage. 2010. Accessed December 28, 2018.

5. Badan Penelitian Dan Pengembangan Kesehatan. Riset Kesehatan Dasar. 2013. Accessed December 28, 2018.

6. Department of Reproductive Health And Research. WHO Statement On Caesarean Section Rates. 2015.;jsessionid=5571863D2208D343400A259B4338731C?sequence=1.

7. Ismail A, Sulong S, Ahmad Z et al., Implementation of Clinical Pathways in Malaysia : Can Clinical Pathways Improve The Quality Of Care? International Medical Journal. 2016;23(1):47-50.

8. Bai J, Bai F, Zhu H, Xue D. The Perceived And Objectively Measured Effects Of Clinical Pathways’ Implementation On Medical Care In China. Kou YR, ed. PLOS ONE. 2018;13(5):e0196776.

9. Lin D-X, Li X, Ye Q-W, Lin F, Li L-L, Zhang Q-Y. Implementation of a Fast-Track Clinical Pathway Decreases Postoperative Length of Stay and Hospital Charges for Liver Resection. Cell Biochemistry and Biophysics. 2011;61(2):413-419.

10. Fadilah NFN, Budi SC. Efektifitas Implementasi Clinical Pathway Terhadap Average Length Of Stay dan Outcomes Pasien DF-DHF Anak di RSUD Kota Yogyakarta. Jurnal Kesehatan Vokasional. 2018;2(2):175.

11. Pahriyani A, Andayani TM, Pramantara IDP. Pengaruh Implementasi Clinical Pathway Terhadap Luaran Klinik dan Ekonomik Pasien Acute Coronary Syndrome. Jurnal Manajemen dan Pelayanan Farmasi.2014;4:146-150.

12. Rahmawati CL, Pinzon RT, Lestari T. Evaluasi Implementasi Clinical Pathway Appendicitis Elektif Di RS Bethesda Yogyakarta. Berkala Ilmiah Kedokteran Duta Wacana. 2017;2(3):437.

13. Pinzon R, Asanti L, Widyo K. Clinical Pathway Dalam Pelayanan Stroke Akut: Apakah Pathway Memperbaiki Proses Pelayanan?. Jurnal Manajemen Pelayanan Kesehatan. 2009;12(01):20-23.

14. Welsh Goverment. All Wales Fundamentals of Care Audit. 2014:35.

15. He XY, Bundorf MK, Gu JJ, Zhou P, Xue D. Compliance with clinical pathways for inpatient care in Chinese public hospitals. BMC Health Services Research. 2015;15(1):1-9.

16. Sari I, Sundari S. Evaluasi Implementasi Clinical Pathway Krisis Hipertensi Di Instalasi Rawat Inap RS PKU Muhammadiyah Bantul. Proceeding Health Architecture. 2017;1(1):113-121.

17. Mutmainah N, Setyati P, Handasari N. Evaluasi Penggunaan dan Efektivitas Antibiotik Profilaksis pada Pasien Bedah Sesar di Rumah Sakit Surakarta Tahun 2010. Indonesian Journal of Clinical Pharmacy. 2014;3(2):44-49.

18. Carvalho B, Butwick AJ. Postcesarean delivery analgesia. Best Practice & Research Clinical Anaesthesiology. 2017;31(1):69-79.

19. Salim R, Braverman M, Berkovic I, Suliman A, Teitler N, Shalev E. Effect of interventions in reducing the rate of infection after cesarean delivery. Am J Infect Control. 2011;39(10):e73-78.

20. Wilson J, Wloch C, Saei A et al., Inter-hospital comparison of rates of surgical site infection following caesarean section delivery: evaluation of a multicentre surveillance study. J Hosp Infect. 2013;84(1):44-51.

21. Nurwahyuni A, Sjaaf AC, Hapsari WP, Nugraha RR. Compliance with Clinical Pathway for Cesarean Section Before and After the Implementation of JKN in Hospital X. KnE Life Sciences. 2018:29-40.

22. Whittle C. ICPAT: Integrated Care Pathways Appraisal Tool. International Journal of Care Pathways. 2009;13(2):75-77.


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