The role of clinical pathways on healthcare quality improvement in hospitals for patient undergoing total hip replacement

Abstract

Background: Clinical pathways are important tools to achieve better quality of care and to reduce the costs for healthcare system. The total hip replacement (THR) is among the most expensive procedures in health system and the number of these operations has greatly increased in the past decade in the Republic of Srpska. Aim: The aim of the present study was to determine how the implementation of a clinical pathway for THR can influence the length of stay and postoperative complications in hospitals in the Republic of Srpska. Methods: This prospective and comparative study was performed on 2,485 patients who underwent the THR over a 3-year-period in 2012 (prior to the introduction of the clinical pathways, baseline), in 2013 (first evaluation period) and in 2014 (second evaluation period), one and two years after its implementation, respectively. The study was conducted in 10 hospitals in the Republic of Srpska, where the effects of the clinical pathways on length of stay and postoperative complications after THR were measured. Results: The introduction of THR clinical pathways significantly decreased the length of stay in hospital from 14.53 ± 7.03 days measured at baseline, to 12.79 ± 4.81 days and 11.19 ± 4.11 days at first and second evaluation period, respectively. At the same time, the number of early postoperative complications such as death and venous thromboembolism significantly decreased in both groups, while the number of dislocations, as parameter of late complications, decreased just after the second evaluation period. For all other complications, such as revision procedures, infections and periprosthetic fracture, there were no statistical differences after the implementation of clinical pathways. Conclusion: The introduction of clinical pathways was successful in reducing the length of stay in hospitals as well as the postoperative complications after THR.

Short-term training of family medicine teams on cardiovascular risk assessment and management: Effects on practice and outcomes

“…[12][13][14] The importance of guidelines implementation at primary and secondary level in RS/B&H was investigated in the past as well. 7,15 The results of this study showed a decreasing number of hypertensive patients with irregular BP level after CVRAM training workshop. Majority of hypertensive patients had a well-controlled BP and the percentage of those with achieved target values was significantly increased after the training workshop of FMTs.…”

Primary hip and knee arthroplasty at district level is safe and may reduce the burden on tertiary care in a low-income setting

“…The arthroplasty theatre complexes were equivalent in both hospitals, but laminar flow was only available in the TH operating rooms. Similar clinical pathways for arthroplasty surgery were used in both hospitals including antiseptic skin preparation, sterile surgical site draping and antibiotic prophylaxis as recommended by the NICE guidelines [ 25 – 28 ]. Patients received one dose of first-generation Cephalosporin antibiotic; or Clindamycin for those with penicillin allergy; prior to skin incision and 3 doses postoperatively.…”

COVID-19 pandemic, passing of professor Folke Sjöqvist and other topics

“…8 The other main impression is contained in the obituary honouring late Professor Folke Sjöqvist, one of the founders of clinical pharmacology as a discipline in Europe, 9 to whom many of us and the entire discipline are indebted to. Since our journal covers all fields of medicine, the remaining articles bring the results of some basic pharmacological experiments on the role of GABA A receptors in vasodilation, 10 on the role of clinical pathways in quality improvement in patients undergoing total hip replacement 11 and describe some clinical studies performed in the fields of ophthalmology 12 and hepatic resections in metastatic colorectal cancer surgery, 13 followed by a case report on hypofibrinogenaemia in pregnancy. 14 Of course, the Editorial Board will continue to follow the COVID-19 pandemic as it evolves, but at the same time will try to provide to its readers coverage of all other interesting topics.…”