Effects of a clinical pathway on quality of care in kidney transplantation: a non-randomized clinical trial

Abstract

Implementation of a CP for KT improves the quality of perioperative treatment by standardizing care. Regarding effects on outcome, no clear conclusion can be drawn. We recommend that large randomized studies are conducted to evaluate the latter issue.

Does the Implementation of Clinical Pathways Affect Hierarchical Structures Within a Surgical Department? A Qualitative Study

“…In the department, CPs have been implemented for several surgical procedures. At the time of study conduction, this had been the case for kidney transplantation, 11 4 different thoracic procedures, 12,14 and 2 colorectal surgeries. 13,24 After this study, additional CPs have been implemented for bariatric surgery, 25 pancreatic, hepatic, and upper gastrointestinal resections.…”

“…Implementation followed a defined protocol, which has been previously described. [11][12][13][14]24,25 CPs were introduced upon the initiative of 1 consultant (MS), who was closely assisted by a resident (UR). The head of department granted approval and support for the CP program, but was not actively involved in implementation.…”

“…Changes in process and outcome quality following CP implementation and compliance with the CPs were evaluated in a number of studies. [11][12][13][14]24,25 These showed that, depending on the specific CP, deviations from the CP were rather frequent, but often limited to single treatment steps (e.g., drains removed later than stipulated in the CP). In case of deviations, patients were continued to be treated according to the CP to the possible extent.…”

“…In surgery, it has been shown that the implementation of a CP is associated with improvements in process and outcome quality, measured, among other indicators, by morbidity, mortality, cost, and patient satisfaction. [8][9][10][11][12][13][14] Studies have also explored determinants of successful CP implementation, and what effects CPs have on processes and management structures within institutions. Although many reports were based on theoretical frameworks and individual perceptions, [15][16][17][18][19] fewer studies have collected evidence using a structured quantitative or qualitative approach.…”

Surgical intensive care unit – essential for good outcome in major abdominal surgery?

“…Their implementation into intensive care may ensure that defined, evidence-based standards are transferred to the patient's bedside and may reduce the variability in clinical practice, especially for more complex abdominal surgery where the postoperative risk of complications is high. Schwarzbach et al evaluated the effects of clinical pathways in kidney transplantation and pulmonary surgery on quality of care and confirmed an improvement of process quality, such as control of cyclosporine levels, catheter removal, and respiratory exercising [93][94][95]. In a systematic review, Lemmens et al analyzed the content of clinical pathways for digestive surgery and their effects on postoperative outcome measures [96].…”