IMPLEMENTATION OF A CLINICAL PATHWAY DECREASES LENGTH OF STAY AND HOSPITAL CHARGES FOR PATIENTS UNDERGOING TOTAL COLECTOMY AND ILEAL POUCH-ANAL ANASTOMOSIS

Background. Clinical pathways are increasingly being used by hospitals to improve efficiency in the care of certain patient populations; how ever, little prospective data are available to support their use. This study examined whether using a clinical pathway for patients undergoi ng ileal pouch/anal anastomosis, a complex procedure in which we had e xtensive practical experience affected hospital charges or length of s tay (LOS). Methods. A clinical pathway was developed to serve patients undergoing-elective total colectomy and ileal pouch/anal anastomosis. All operations were performed by two attending physicians (J.E.F., M. S.N.). Before implementation, 10 Pilot patients were prospectively mon itored to ensure that hospital charges were accurately generated. In a ddition, charge audits were Performed by an outside agency to verify t he accuracy of the hospital bills. The pathway was then implemented, a nd 14 patients were prospectively analyzed. Results. In all patients t he principal diagnosis was ulcerative colitis, with the exception of t hree patients with familial polyposis. Mean external audit charges wer e within 2% of the hospital bills; therefore the hospital bills were u sed in all calculations. The mean LOS decreased from 10.3 days to 7.5 days (p = 0.046) for patients on the pathway versus pilot patients. Me an hospital charges also decreased significantly, from $21,650 to $17, 958 per patient (p = 0.005). Conclusions. Implementation of a clinical pathway, even for an operation in which the surgeon has much experien ce, is an effective method for reducing LOS and charges for patients. This is likely the result of interdisciplinary cooperation, eliminatio n of unnecessary interventions, and streamlined involvement of ancilla ry services. These results support the development of clinical pathway s for procedures that involve routine preoperative and postoperative c are. In addition, the benefits of clinical pathways should increase pr oportionally with increasing case volume for a particular procedure.