CRITICAL PATHWAYS FOR HEAD AND NECK-SURGERY - DEVELOPMENT AND IMPLEMENTATION

Objective: To design, implement, and study the effectiveness of 4 new critical pathways relevant to head and neck oncological care. Design: Before-after trial. Setting: Tertiary referral academic institution. P atients: Sixty-eight patients admitted for head and neck oncological s urgery or chemotherapy from December 1, 1995, through May 31, 1996; 30 patients with similar diagnoses and who underwent surgical procedures from December 1, 1994, to December 1, 1995, who served as historical controls. Interventions: Implementation of 4 critical pathways: chemot herapy, clean head and neck surgery; clean contaminated head and neck surgery, clean contaminated head and neck surgery with reconstructive flap. Main Outcome Measures: Length of stay, cost of hospitalization, and variance tracking (deviations from established standards). Results : The length of stay for the clean contaminated group without flap rec onstruction decreased by 1.5 days, and costs decreased by $7407 per pa tient (P<.05, Student t test). The length of stay decreased 1.6 days i n the clean contaminated group with flap reconstruction, and costs dec reased $9845 per patient (P<.05, Student t test). Nine patients (13%) experienced a prolonged length of stay while on a critical pathway. Co nclusions: Implementation of critical pathways has resulted in a decre ased overall length of stay and cost of hospitalization. It has also a llowed for better coordination and documentation of patient care, whil e the tracking of variances has simplified problem identification and correction.