The purpose of this study was to develop a clinical pathway for post-operative care of patients who have undergone a laparoscopic cholecystectomy and to determine the time- and cost-effectiveness using the Clinical Pathway Assistant （CPA） program. The procedure was performed with the following steps: establishment of a conceptual framework, development of a preliminary clinical pathway using the CPA program, expert validity test, and confirmation of the final clinical pathway. The patient’s admission period with respect to time- and cost-effectiveness was confirmed as 3 days, and each item of assessment, test, medication, treatment, diet, activity, and teaching were finalized. It was verified that the time and cost to develop a clinical pathway can be reduced by the CPA program, because this program can automate the complicated process, which consists of collecting and cleaning the large size EMR data, classifying, and confirming the items in the clinical pathway.

　Acute appendicitis is the most common condition behind acute abdomen for children. Perforation cases due to diagnostic delay or negative appendectomy by uncertain diagnosis remain a serious issue. We made a clinical pathway in 2001 and developed a diagnostic score in 2005 for acute appendicitis among children. In order to clarify the effect of the clinical pathway and the diagnostic score, we divided 183 children, ≦15 years old, who underwent appendectomy between 1998 and 2008 into three periods（1st period; Pre-path, 2nd period; Post-path, 3rd period; Post-score）. When the 2nd period was compared with the 1st period, postoperative complications decreased to 2.9％ from 22.8％（to 0％ from 8.5％ in non-perforation cases, and to 20％ from 90％ in perforation cases）. Average postoperative hospitalization was significantly shortened from 8.5±4.2 days to 3.4 ± 4.0 days. Furthermore, the negative appendectomy rate also decreased to 5.7％ in the 3rd period by using the appendicitis diagnostic score. In order to make a clinical pathway, it is necessary to review the past cases and to build scientific evidence in each procedure of treatment. Many problems and solutions will be clarified in those processes. We must continuously revise the clinical pathway by repeating hypothesis and verification.