Implementation of a clinical pathway decreases length of stay and hospital charges for patients undergoing total colectomy and ileal pouch/anal anastomosis
| Autor: | Scott C. Hobler, Robert H. Bower, Robert J. Burnett, Josef E. Fischer, Linda V. Flesch, Michael S. Nussbaum, Stephen B. Archer |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Psychological intervention Rectum Anal Canal Pilot Projects Anastomosis Clinical pathway medicine Humans Prospective Studies Prospective cohort study Colectomy Patient Care Team Proctocolectomy business.industry Anastomosis Surgical Proctocolectomy Restorative Length of Stay medicine.disease Ulcerative colitis Surgery Hospitalization medicine.anatomical_structure Adenomatous Polyposis Coli Costs and Cost Analysis Critical Pathways Colitis Ulcerative Female Pouch business |
| Zdroj: | Surgery. 122(4) |
| ISSN: | 0039-6060 |
| Popis: | Background . Clinical pathways are increasingly being used by hospitals to improve efficiency in the care of certain patient populations; however, little prospective data are available to support their use. This study examined whether using a clinical pathway for patients undergoing ileal pouch/anal anastomosis, a complex procedure in which we had extensive practical experience, affected hospital charges or length of stay (LOS). Methods . A clinical pathway was developed to serve patients undergoing elective total colectomy and ileal pouch/anal anastomosis. All operations were performed by two attending physicians (J.E.F., M.S.N.). Before implementation, 10 pilot patients were prospectively monitored to ensure that hospital charges were accurately generated. In addition, charge audits were performed by an outside agency to verify the accuracy of the hospital bills. The pathway was then implemented, and 14 patients were prospectively analyzed. Results . In all patients the principal diagnosis was ulcerative colitis, with the exception of three patients with familial polyposis. Mean external audit charges were within 2% of the hospital bills; therefore the hospital bills were used in all calculations. The mean LOS decreased from 10.3 days to 7.5 days (p = 0.046) for patients on the pathway versus pilot patients. Mean hospital charges also decreased significantly, from $21,650 to $17,958 per patient (p = 0.005). Conclusions . Implementation of a clinical pathway, even for an operation in which the surgeon has much experience, is an effective method for reducing LOS and charges for patients. This is likely the result of interdisciplinary cooperation, elimination of unnecessary interventions, and streamlined involvement of ancillary services. These results support the development of clinical pathways for procedures that involve routine preoperative and postoperative care. In addition, the benefits of clinical pathways should increase proportionally with increasing case volume for a particular procedure. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect