Evaluation of the Clinical Pathway for Laparoscopic Cholecystectomy

Abstract

Clinical pathways are comprehensive systematized patient care plans for specific procedures. The clinical pathway for laparoscopic cholecystectomy was implemented in our department in March 2002. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation. A study was conducted on all the patients included in the clinical pathway since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year prior to implementation of the clinical pathway. As our hospital has a system of cost management, we analyzed the mean cost per procedure before and after clinical pathway implementation. Evaluation was made of a series of 160 consecutive patients who underwent surgery during the period 1 year prior to development of the clinical pathway and met the accepted inclusion criteria. The mean length of hospital stay was 3.27 days, and the mean cost per procedure before pathway implementation was 2149 (±768) euros. One year after implementation of the pathway, 140 patients were included (i.e., an inclusion rate of 100%). The mean length of hospital stay of the patients included in the clinical pathway was 2.2 days. The degree of compliance with stays was 66.7 per cent. The most frequent reasons for noncompliance were staff-dependent, followed by patient-dependent causes (oral intolerance, pain, etc.). The mean cost in the series of patients included in the clinical pathway was 1845 (± 618) euros. Laparoscopic cholecystectomy is an ideal procedure for commencing the systemization of clinical pathways. Results show that it has significantly reduced the length of hospital stay and mean cost per procedure with no increased morbidity and with a high degree of patient satisfaction.

Improved outcomes with implementation of an Enhanced Recovery After Surgery pathway for patients undergoing elective colorectal surgery in the Philippines

“…1,2 It is a bundle of "best evidence-based practices" delivered by a multi-professional health care team, with the intention of assisting patients to recuperate expeditiously after surgery. 1 Clinical, or critical, pathways have been described to improve outcomes in various fields of surgery, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] including colorectal surgery. [17][18][19][20][21][22][23] Clinical pathways designed for the colorectal surgery patient have resulted in decreased hospital length of stay (LOS); decreased cost; and decreased, or no difference, in morbidity rates when compared to conventional care.…”

Systematic review and meta-analysis of factors which reduce the length of stay associated with elective laparoscopic cholecystectomy

“…Implementation of a dedicated care pathway for patients undergoing elective LC was examined in 10 non-randomized studies. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 14 , 31 , 32 Implementation of a care pathway was associated with a significantly shorter mean LOS (MD 24.9 h; 95% CI, 18.7–31.2; p < 0.001; Fig. 3 a) and an improved day case rate (OR, 3.5; 95% CI, 1.5–8.1; p = 0.005; Fig.…”

“…2 , 3 , 4 , 5 Implementation of standard clinical pathways for LC have been reported to successfully reduce LOS and increase day case success. 6 , 7 , 8 , 9 , 10 , 11 , 12 Day case laparoscopic cholecystectomy (DCLC) is associated with cost-savings 3 , 13 , 14 without increasing the risk of adverse events or readmissions. 3 , 15 , 16 It has a high rate of patient satisfaction 17 , 18 and is comparable with inpatient stay with respect to quality of life, return to work and normal activity.…”

Evaluation of a Clinical Pathway to Improve Colorectal Cancer Outcomes

“…The positive outcomes of CP implementation have been demonstrated widely in processes with a predictable clinical course such as cholecystectomy, 4 thyroidectomy, 6 herniorrhaphy, prostatectomy, mastectomy, or bariatric surgery. There are also studies that demonstrate their usefulness in colorectal surgery.…”

“…There are various methods for this, among which are protocols and clinical pathways (CPs). [1][2][3] A number of CPs have been developed and published in the field of general and digestive surgery, notably those for cholecystectomy, 4 mastectomy, 5 thyroidectomy, 6 and appendectomy. 7 However, there are few studies in the literature regarding the development of CPs for complex processes or processes with a less predictable clinical course such as colorectal carcinoma, 8 pneumothorax, 9 and diabetic foot.…”