Literature DB >> 10561099

Implementation of a clinical pathway decreases length of stay and cost for bowel resection.

T A Pritts1, M S Nussbaum, L V Flesch, E J Fegelman, A A Parikh, J E Fischer.   

Abstract

OBJECTIVE: To examine the effect of a clinical pathway for small and large bowel resection on cost and length of hospital stay. SUMMARY BACKGROUND DATA: Clinical pathways are designed to streamline patient care delivery and maximize efficiency while minimizing cost. Theoretically, they should be most effective in commonly performed procedures, in which volume and familiarity are high.
METHODS: A clinical pathway to assist in the management of patients undergoing bowel resection was developed by a multidisciplinary team and implemented. Data about length of stay and cost was collected for all patients undergoing bowel resection 1 year before and 1 year after pathway implementation. Three groups were compared: patients undergoing bowel resection in the year prior to pathway implementation (prepathway), patients in the year after pathway implementation but not included on the pathway (nonpathway), and patients included in the pathway (pathway).
RESULTS: The mean cost per hospital stay was $19,997.35 +/- 1244.61 for patients in the prepathway group, $20,835.28 +/- 2286.26 for those in the nonpathway group, and $13,908.53 +/- 1113.01 for those in the pathway group (p < 0.05 vs. other groups). Mean postoperative length of stay was 9.98 +/- 0.62 days (prepathway), 9.68 +/- 0.88 days for (nonpathway), and 7.71 +/- 0.37 days (pathway) (p < 0.05 vs. other groups).
CONCLUSIONS: Implementation of the pathway produced significant decreases in length of stay and cost in the pathway group as compared to the prepathway group. These results support the further development of clinical pathways for general surgical procedures.

Entities:  

Mesh:

Year:  1999        PMID: 10561099      PMCID: PMC1420929          DOI: 10.1097/00000658-199911000-00017

Source DB:  PubMed          Journal:  Ann Surg        ISSN: 0003-4932            Impact factor:   12.969


  14 in total

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2.  General surgical clinical pathways: an introduction.

Authors:  T R Gadacz; R B Adkins; J P O'Leary
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3.  Utility of clinical pathway and prospective case management to achieve cost and hospital stay reduction for aortic aneurysm surgery at a tertiary care hospital.

Authors:  S C Muluk; L Painter; S Sile; R Y Rhee; M S Makaroun; D L Steed; M W Webster
Journal:  J Vasc Surg       Date:  1997-01       Impact factor: 4.268

Review 4.  Quality assurance and medical outcomes in the era of cost containment.

Authors:  F X Campion; M S Rosenblatt
Journal:  Surg Clin North Am       Date:  1996-02       Impact factor: 2.741

5.  Cost-efficient radical prostatectomy.

Authors:  M O Koch
Journal:  Semin Urol Oncol       Date:  1995-08

6.  Why use clinical pathways rather than practice guidelines?

Authors:  D E Weiland
Journal:  Am J Surg       Date:  1997-12       Impact factor: 2.565

7.  Critical pathways for head and neck surgery. Development and implementation.

Authors:  J Cohen; M Stock; P Andersen; E Everts
Journal:  Arch Otolaryngol Head Neck Surg       Date:  1997-01

8.  Impact of clinical pathways on hospital costs and early outcome after major vascular surgery.

Authors:  K D Calligaro; M J Dougherty; C A Raviola; D J Musser; D A DeLaurentis
Journal:  J Vasc Surg       Date:  1995-12       Impact factor: 4.268

9.  Critical pathways as a strategy for improving care: problems and potential.

Authors:  S D Pearson; D Goulart-Fisher; T H Lee
Journal:  Ann Intern Med       Date:  1995-12-15       Impact factor: 25.391

10.  A meta-analysis of selective versus routine nasogastric decompression after elective laparotomy.

Authors:  M L Cheatham; W C Chapman; S P Key; J L Sawyers
Journal:  Ann Surg       Date:  1995-05       Impact factor: 12.969

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  25 in total

1.  Compliance and efficiency before and after implementation of a clinical practice guideline for laryngeal carcinomas.

Authors:  Michel van Agthoven; Hélène A G Heule-Dieleman; Paul P Knegt; Johannes H A M Kaanders; Robert J Baatenburg de Jong; Bernd Kremer; C René Leemans; Henri A M Marres; Johannes J Manni; Johannes A Langendijk; Peter C Levendag; Reina E Tjho-Heslinga; Joseph M A de Jong; Maarten F de Boer; Carin A Uyl-de Groot
Journal:  Eur Arch Otorhinolaryngol       Date:  2006-05-14       Impact factor: 2.503

Review 2.  Clinical Pathways in surgery: should we introduce them into clinical routine? A review article.

Authors:  Ulrich Ronellenfitsch; Eric Rössner; Jens Jakob; Stefan Post; Peter Hohenberger; Matthias Schwarzbach
Journal:  Langenbecks Arch Surg       Date:  2008-02-23       Impact factor: 3.445

3.  The association between clinical pathways and hospital length of stay: a case study.

Authors:  Keon-Hyung Lee; Yvonne M Anderson
Journal:  J Med Syst       Date:  2007-02       Impact factor: 4.460

4.  Impact of clinical pathways in surgery.

Authors:  Markus K Müller; Konstantin J Dedes; Daniel Dindo; Stefan Steiner; Dieter Hahnloser; Pierre-Alain Clavien
Journal:  Langenbecks Arch Surg       Date:  2008-06-03       Impact factor: 3.445

Review 5.  Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery: a review of the literature.

Authors:  Anna R Gagliardi; Darlene Fenech; Cagla Eskicioglu; Avery B Nathens; Robin McLeod
Journal:  Can J Surg       Date:  2009-12       Impact factor: 2.089

Review 6.  Systematic review and meta-analysis of the use of serum procalcitonin levels to predict intra-abdominal infections after colorectal surgery.

Authors:  Winson Jianhong Tan; Wan Qi Ng; Rehena Sultana; Nurun Nisa de Souza; Min Hoe Chew; Fung Joon Foo; Choong Leong Tang; Wah Siew Tan
Journal:  Int J Colorectal Dis       Date:  2018-01-05       Impact factor: 2.571

7.  [IT-based clinical pathway as a routine tool in trauma surgery].

Authors:  L Homagk; O Deml; G O Hofmann
Journal:  Unfallchirurg       Date:  2012-12       Impact factor: 1.000

8.  The effect of a clinical pathway for enhanced recovery of rectal resections on perioperative quality of care.

Authors:  J Hardt; M Schwarzbach; T Hasenberg; S Post; P Kienle; U Ronellenfitsch
Journal:  Int J Colorectal Dis       Date:  2013-02-01       Impact factor: 2.571

Review 9.  A systematic review of strategies to improve prophylaxis for venous thromboembolism in hospitals.

Authors:  Rebecca Tooher; Philippa Middleton; Clarabelle Pham; Robert Fitridge; Siohban Rowe; Wendy Babidge; Guy Maddern
Journal:  Ann Surg       Date:  2005-03       Impact factor: 12.969

10.  Compliance of Clinical Pathways in Elective Laparoscopic Cholecystectomy: Evaluation of Different Implementation Methods.

Authors:  Martin Holderried; Rebecca Hummel; Claudius Falch; Andreas Kirschniak; Alfred Koenigsrainer; Christian Ernst; Sven Muller
Journal:  World J Surg       Date:  2016-12       Impact factor: 3.352

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