ObjectiveTo determine the success of a clinical pathway for outpatient laparoscopic cholecystectomy (LC) in an academic health center, and to assess the impact of pathway implementation on same-day discharge rates, safety, patient satisfaction, and resource utilization. Summary Background DataLaparoscopic cholecystectomy is reported to be safe for patients and acceptable as an outpatient procedure. Whether this experience can be translated to an academic health center or larger hospital is uncertain. Clinical pathways guide the care of specific patient populations with the goal of enhancing patient care while optimizing resource utilization. The effectiveness of these pathways in achieving their goals is not well studied. MethodsDuring a 12-month period beginning April 1, 1999, all patients eligible for an elective LC (n ϭ 177) participated in a clinical pathway developed to transition LC to an outpatient procedure. These were compared with all patients undergoing elective LC (n ϭ 208) in the 15 months immediately before pathway implementation. Successful same-day discharges, reasons for postoperative admission, readmission rates, complications, deaths, and patient satisfaction were compared. Average length of stay and total hospital costs were calculated and compared. ResultsAfter pathway implementation, the proportion of same-day discharges increased significantly, from 21% to 72%. Unplanned postoperative admissions decreased as experience with the pathway increased. Patient characteristics, need for readmission, complications, and deaths were not different between the groups. Patients surveyed were highly satisfied with their care. Resource utilization declined, resulting in more available inpatient beds and substantial cost savings.

Patient functional activity and mobility are essential to recovery and minimization of the risks associated with immobility in hospitalized patients. In practice, there is inconsistency in attending to this aspect of patient care and limited information in the literature to guide clinicians caring for medical-surgical patients. An interdisciplinary quality improvement team of nurses, physical therapists, occupational therapists, and patient care assistants developed a programmatic approach to the assessment, planning, and implementation of patient activity criteria in this patient population. Increased awareness and application of the patient activity criteria have improved the consistency with which patient activity is addressed and reduced the incidence of immobility-associated complications.