BACKGROUND: One strategy to reduce the consumption of resources associated to specific procedures is to utilize clinical pathways, in which surgical care is standardized and preset by determination of perioperative in-hospital processes. The aim of this prospective study was to establish the impact of clinical pathways on costs, complication rates, and nursing activities. METHOD: Data was prospectively collected for 171 consecutive patients undergoing laparoscopic cholecystectomy (n = 50), open herniorrhaphy (n = 56), and laparoscopic Roux-en-Y gastric bypass (n = 65). RESULTS: Clinical pathways reduced the postoperative hospital stay by 28% from a mean of 6.1 to 4.4 days (p < 0.001), while the 30-day readmission rate remained unchanged (0.5% vs. 0.45%). Total mean costs per case were reduced by 25% from euro 6,390 to euro 4,800 (p < 0.001). Costs for diagnostic tests were reduced by 33% (p < 0.001). Nursing hours decreased, reducing nursing costs by 24% from euro 1,810 to euro 1,374 (p < 0.001). A trend was noted for lower postoperative complication rates in the clinical pathway group (7% vs. 14%, p = 0.07). CONCLUSIONS: This study demonstrates clinically and economically relevant benefits for the utilization of clinical pathways with a reduction in use of all resource types, without any negative impact on the rate of complications or re-hospitalization.
BACKGROUND: One strategy to reduce the consumption of resources associated to specific procedures is to utilize clinical pathways, in which surgical care is standardized and preset by determination of perioperative in-hospital processes. The aim of this prospective study was to establish the impact of clinical pathways on costs, complication rates, and nursing activities. METHOD: Data was prospectively collected for 171 consecutive patients undergoing laparoscopic cholecystectomy (n = 50), open herniorrhaphy (n = 56), and laparoscopic Roux-en-Y gastric bypass (n = 65). RESULTS: Clinical pathways reduced the postoperative hospital stay by 28% from a mean of 6.1 to 4.4 days (p < 0.001), while the 30-day readmission rate remained unchanged (0.5% vs. 0.45%). Total mean costs per case were reduced by 25% from euro 6,390 to euro 4,800 (p < 0.001). Costs for diagnostic tests were reduced by 33% (p < 0.001). Nursing hours decreased, reducing nursing costs by 24% from euro 1,810 to euro 1,374 (p < 0.001). A trend was noted for lower postoperative complication rates in the clinical pathway group (7% vs. 14%, p = 0.07). CONCLUSIONS: This study demonstrates clinically and economically relevant benefits for the utilization of clinical pathways with a reduction in use of all resource types, without any negative impact on the rate of complications or re-hospitalization.
Authors: Kim A Eagle; Peter B Berger; Hugh Calkins; Bernard R Chaitman; Gordon A Ewy; Kirsten E Fleischmann; Lee A Fleisher; James B Froehlich; Richard J Gusberg; Jeffrey A Leppo; Thomas Ryan; Robert C Schlant; William L Winters; Raymond J Gibbons; Elliott M Antman; Joseph S Alpert; David P Faxon; Valentin Fuster; Gabriel Gregoratos; Alice K Jacobs; Loren F Hiratzka; Richard O Russell; Sidney C Smith Journal: J Am Coll Cardiol Date: 2002-02-06 Impact factor: 24.094
Authors: Sydney Morss Dy; Pushkal P Garg; Dorothy Nyberg; Patricia B Dawson; Peter J Pronovost; Laura Morlock; Haya R Rubin; Marie Diener-West; Albert W Wu Journal: Med Care Date: 2003-05 Impact factor: 2.983
Authors: Brad W Warner; Kate A Rich; Harry Atherton; Charlotte L Andersen; Uma R Kotagal Journal: Semin Pediatr Surg Date: 2002-02 Impact factor: 2.754
Authors: G A Porter; P W Pisters; C Mansyur; A Bisanz; K Reyna; P Stanford; J E Lee; D B Evans Journal: Ann Surg Oncol Date: 2000-08 Impact factor: 5.344
Authors: Patrick R Pfau; Gregory S Cooper; Mark D Carlson; Amitabh Chak; Michael V Sivak; Judith A Gonet; Karen K Boyd; Richard C K Wong Journal: Am J Gastroenterol Date: 2004-03 Impact factor: 10.864
Authors: Christina Haane; Wolf Arif Mardin; Britta Schmitz; Sameer Dhayat; Richard Hummel; Norbert Senninger; Christina Schleicher; Soeren Torge Mees Journal: Langenbecks Arch Surg Date: 2013-10-19 Impact factor: 3.445
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