Introduction Clinical pathways (CP) are proven as tool for increasing hospital care efficiency and quality. The Indonesian's government implemented Indonesian Diagnostic Related-Groups (INA-DRGs) based on casemix system; therefore, CP becomes an important tool in reducing hospital costs.

Objective Assessing the effect of CPs implementation in reducing the average length of stay (ALOS) and charge per-case, and increasing use of generic antibiotic.

Method This study was a quasi experimental. The CP was implemented on May 2008 in Djasamen Saragih District Hospital (DSDH) at Pematangsiantar City, North Sumatera. Pirngadi General Hospital (PGH) at Medan, North Sumatera, was acted as control hospital. Total 254 appendectomy cases were analysed, which were consisted 124 cases in DSDH (pre 60 and post 64) and 130 cases in PGH (pre 60 and post 70). The study outcomes were measured 12 months before and after CP implementation and compared between two hospitals.

Result The subject's characteristics were not significant difference between two groups. The ALOS was significantly reduced from 5.2±1.1 days before intervention to 4.8±0.9 after intervention in DSDH, while in control hospital no difference in reducing ALOS (4.9±1.2 to 4.7±1.1). The use of generic antibiotics per-case were raised from 1.5±0.8 to 1.9±0.7 in DSDH, while in control reduced from 2.0±0.9 to 1.9±1.0. The charge per case was not significantly reduced in intervention, nor control hospital.

Conclusion Clinical pathways trends to improve hospital ALOS, generic use of antibiotics and charge per case, therefore, the CP may effective method to increase efficiency in hospital care.