Implementation of a care pathway for infantile hypertrophic pyloric stenosis reduces length of stay and increases parent satisfaction

Abstract

Introduction: Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical condition, but there are no guidelines regarding preoperative fluid resuscitation. Our aim was to evaluate a novel consensus care pathway for IHPS, incorporating a standardized fluid and electrolyte replacement regime. Methods: One hundred patients were initially reviewed and compared to thirty-three patients following the introduction of a clinical pathway, whereby infants requiring electrolyte correction received 150 ml/kg/24 h of 0.45% saline, 5% dextrose and 10 mmol KCl, with systematic blood sampling until correction was achieved. We measured time to electrolyte correction, time to surgery and total length of hospitalization. Data were described using the median and interquartile range, and differences between the groups' categorical and continuous data were described using Chisquared and the Mann-Whitney U-tests, respectively. Results: Time in hours taken to correct electrolytes was reduced: 25(16.5-42) versus 9.5(4.5-24.75) p ¼ 0.004. Time to surgery from admission in uncorrected patients decreased from 50(40.25-66.75) to 39(28.75-41.75) p ¼ 0.018. Subsequently, there was a reduction in total length of stay: 94(71-93.5) versus 75(64.5-93.5) p ¼ 0.025. Parental satisfaction increased from 77% in the pre-pathway group to 83% in the pathway group. Conclusion: A consensus care pathway for IHPS reduces the time taken to correct preoperative electrolyte abnormalities, decreases length of hospitalization and improves parental satisfaction.

Care coordination and its evaluation: From big data to big picture

“…In three other papers, the challenges of implementing care coordination are presented. Cooper et al 9 reveal their plan to implement patient-centred care in the context of an integrated care program, and Wetherill et al 10 present the results of implementing a care pathway for infantile hypertrophic pyloric stenosis on length of stay and parent satisfaction. Based on insights from organization theory on coordination in theory and in action, Praetorius and Becker 11 answer the question: how to achieve care coordination inside health care organizations?…”

Enhancing Clinical Outcomes and Quality of Life in Acute Myocardial Infarction Patients Through Standard Clinical Pathway Implementation: A Study From a Public Tertiary Care Hospital in Karachi, Pakistan

“…7 These pathways, grounded in evidence-based practices, tailor treatment approaches to specific patient populations and healthcare settings, promoting standardized, efficient care delivery. 8 However, successful implementation necessitates effective collaboration among healthcare professionals, ensuring coordinated, patient-centered care. www.pakheartjournal.com Employing clinical pathways enhances clinical effectiveness and patient outcomes by aligning practices with evidence-based guidelines.…”

Evaluasi Kepatuhan Petugas Kesehatan dalam Implementasi Clinical Pathway di RS Islam Surabaya Ahmad Yani

“…Pengembangan awal clinical pathway dialkukan di Amerika Serikat, Australia dan Inggris sebagai cara untuk meningkatkan efisensi dan mengurangi biaya klinis (10). Dewasa ini clinical pathway telah digunakan di berbagai rumah sakit dan organisasi kesehatan di dunia sebagai alat audit dan penjaminan kualitas (5) (11). Pada tahun 2016, RS Islam Surabaya Ahmad Yani telah mendapatkan akreditasi paripurna dari Komite Akreditasi Rumah Sakit (KARS) dan menunjukkan upaya peningkatan mutu hingga kini.…”