Colorectal Clinical Pathways: A Method of Improving Clinical Outcome?

Tan, Jane Jye-Yng; Foo, Angel Y.Z.; Cheong, Denis M. O.

doi:10.1016/s1015-9584(09)60355-9

Cited by 18 publications

(17 citation statements)

References 11 publications

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“…1) [19,20,21,22,23,24,25,26,27,28,29,30,31]. Seven (54%) of the 13 articles concerned studies about the evaluation of clinical pathways in the USA, 2 (15%) Germany, 2 (15%) Japan, 1 (8%) concerned Denmark, and 1 (8%) concerned Singapore.…”

Section: Resultsmentioning

confidence: 99%

Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review

Lemmens

Zelm²,

Rinkes

et al. 2009

Dig Surg

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Background/Aims: Oncology surgery of the gastrointestinal tract is complex and infamous for its high complication rates. One of the methods for implementing interventions to optimize the patients’ condition and to enhance postoperative outcome is the development and implementation of a clinical pathway. The aim of this study was to analyze the content, i.e. the interventions of clinical pathways for digestive surgery and their effects on postoperative outcome measures. Methods: We performed a systematic review to study clinical pathways in hospital care for adult patients undergoing elective surgery of the stomach, esophagus, pancreas, liver, colon or rectum. The MEDLINE, EMBASE and CINAHL literature databases were searched. Results: The most common interventions in the clinical pathways in this review were defined in the pre- and postoperative phase and included: nutritional management, pain management, mobilization, education and discharge planning. The primary aim of these interventions was to enhance postoperative recovery. Conclusion: Clinical pathways for digestive surgery contain specific interventions to improve postoperative outcome. Most of these interventions are in accordance with the Enhanced Recovery After Surgery (ERAS) protocol, which is an evidence-based protocol for care after colon resections. They result in reduced length of stay without compromising other postoperative outcome measures.

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Section: Resultsmentioning

confidence: 99%

Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review

Lemmens

Zelm²,

Rinkes

et al. 2009

Dig Surg

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“…Most studies are focusing on one single operation and on length of hospital stay [6][7][8][9][10][11][12][13][14][15] ( Table 4). Costs were only analyzed with the help of general model calculations and resource utilization was not analyzed in detail [22][23][24].…”

Section: Discussionmentioning

confidence: 99%

“…In surgery, the impact of clinical pathways on resource utilization remains unclear. A few studies are available, but are restricted to a single procedure, and cost analyses are mainly based on the length of hospital stay [6][7][8][9][10][11][12][13][14][15] (see Table 4). Most studies come from the US [16] and two thirds of studies on clinical pathways were classified as of low quality [17].…”

Section: Introductionmentioning

confidence: 99%

Impact of clinical pathways in surgery

Müller

Dedes

Dindo

et al. 2008

Langenbecks Arch Surg

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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 € 6,390 to € 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 € 1,810 to € 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.

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“…Of the 465 patient questionnaires returned (RR = 71.4%), 15 were excluded (surgery in 2009 [6]; posttrauma THR [2]; revision THR/TKR [6]; duplicate [1]), leaving 450 questionnaires for analysis. Sample characteristics are outlined in Table 1.…”

Section: Participantsmentioning

confidence: 99%

“…The focus of the literature reporting patient pathways has predominantly been related to strategies for reducing length of stay in hospital, [2][3][4] minimising readmission rates, 2 lowering cost, 3,5 or improving postoperative outcomes, 4,6,7 and most relates to disciplines other than orthopaedic surgery. Other associated studies have focussed on waiting lists and waiting time [8][9][10][11][12][13] and no published literature could be identified reporting the patient pathway from referral to THR or TKR surgery with a focus on the public elective surgery system.…”

Section: Introductionmentioning

confidence: 99%

The journey to total hip or knee replacement

Walters

Mackintosh

Sheppard

2012

Aust. Health Review

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Objectives. Despite the incidence of joint replacements in Australia, there is a paucity of information regarding how patients progress from their referral to their surgery. The aim of this study was to describe a patient pathway from referral to receipt of total hip replacement (THR) or total knee replacement (TKR) surgery in South Australian public hospitals.Methods. Patient perspectives of the pathway to THR and TKR surgery were obtained via a postal survey (n = 450) and hospital employee perspectives were attained via semi-structured interviews (n = 19). Survey data were analysed using descriptive statistics and interview data were analysed thematically.Results. A typical patient pathway to THR and TKR surgery can be divided into two distinct phases; referral-to-initial appointment (9-24 months), and initial appointment-to-surgery (12-15 months). This gives an overall waiting period between 2 and 3 years for THR or TKR surgery.Conclusions. Waiting times for THR and TKR surgery reported in this study were longer than other reports in the literature. Current Australian health policy does not consider the first (and longest) phase of the patient pathway. Excluding this initial phase could be generating an erroneous perception of the patient pathway to THR or TKR surgery, possibly leading to poorly considered health reforms.

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Colorectal Clinical Pathways: A Method of Improving Clinical Outcome?

Abstract: The introduction of a colorectal clinical pathway significantly improved the outcome of patients undergoing major colorectal surgery.

Cited by 18 publications

References 11 publications

Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review

Clinical and Organizational Content of Clinical Pathways for Digestive Surgery: A Systematic Review

Impact of clinical pathways in surgery

The journey to total hip or knee replacement

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