1998 Abstract: IMPLEMENTATION OF A CLINICAL PATHWAY DECREASES LENGTH OF STAY AND COST FOR BOWEL RESECTION. TA Pritts, MS Nussbaum, LV Flesch, EJ Fegelman, AJ Parikh, and JE Fischer. Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio. 41
Abstracts 1998 Digestive Disease Week
#2332
IMPLEMENTATION OF A CLINICAL PATHWAY DECREASES LENGTH OF STAY AND COST FOR BOWEL RESECTION. TA Pritts, MS Nussbaum, LV Flesch, EJ Fegelman, AJ Parikh, and JE Fischer. Department of Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio.
Clinical Pathways are designed to streamline patient care delivery and maximize efficiency while minimizing cost. Despite the growing utilization of these pathways in medicine, their impact has not been extensively investigated. In this study, we examined the effect of a clinical pathway for small and large bowel resection on cost and length of stay. Methods: A clinical pathway to serve patients undergoing bowel resection was developed by a multidisciplinary team and implemented in January 1996. All patients undergoing bowel resection were eligible for inclusion at the discretion of the attending surgeon. Data concerning length of stay and cost was collected retrospectively for all patients undergoing bowel resection in 1995 and prospectively for one year after pathway implementation. The following groups were compared: (1) prepathway implementation, (2) post-pathway implementation but not enrolled in pathway, and (3) participating in pathway. Results: Length of stay (LOS) and cost in the three groups were analyzed by ANOVA with multiple comparisons done by Tukey's test when overall differences were significant. Patient demographics, results, and statistical analyses are summarized in the table below. Values represent means ± SEM where applicable. Costs from 1996 were converted to 1995 dollars by linking 1996 charges to the appropriate 1995 cost.
Group
N
M:F
Age (years)
LOS (days)
Cost
prepathway
167
78:89
57.1 ± 1.3
12.5 ± 0.79
± 1276
nonpathway
69
30:39
50.0 ± 2.3*
1.6 ± 1.07
± 2386
pathway
101
44:57
59.6 ± 1.6
9.4 ± 0.61*
± 1105*
* p value vs.
other groups
< 0.05
0.0207
0.0049
Conclusions: Implementation of the pathway produced significant decreases in length of stay and cost in participating patients. We conclude that a clinical pathway is effective in lowering cost and length of stay even in an operation in which there is a great deal of experience. These results support the further development of clinical pathways for surgical procedures.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
