RADICAL OUTCOME METHOD - A NEW APPROACH TO CRITICAL PATHWAYS IN CONGENITAL HEART-DISEASE

Background Treatment of congenital heart disease has entered a new era of healthcare delivery and cost containment. Critical pathway method (CPM) has been previously demonstrated by us to produce a significant reduction in average length of stay (ALOS) in hospital of -44%. A new approach, radical outcome method (ROM), has produced comparable result s that appear to improve over time. The dynamic nature is examined. Me thods and Results Two hundred consecutive patients with congenital hea rt disease were treated by a single surgeon at a single health mainten ance organization (HMO) facility. ROM was used in all patients. This m ethod uses seven critical moments at which shortening rather than conf irmation of the ALOS is possible. This process is completed by the sec ond post-operative day. Overall mortality was 1%. The 200 patients wer e divided into two consecutive groups of 100 patients to determine the effectiveness of ROM over time. Fifty sets were matched. ALOS hospita l decreased by 29 days (mean, 0.6 d/set), P<.003. Thirty sets who unde rwent cardiopulmonary bypass had a 16% decrease (P<.03), and 20 sets i n whom nonbypass procedures were performed had a decrease of 16% (P<.0 2). ALOS in hospital for the 50 sets decreased from 3.7 to 3.1 days (- 16%, P<.003). Outcome data demonstrated no significant difference. Con clusions ROM, a proactive approach to hospital stay, is a dynamic proc ess that reduces ALOS in hospital. This is achieved by both reducing n egative variation in the standard CPM and allowing for positive variat ion. Outcome data confirm that this approach can reduce ALOS in hospit al while providing optimal patient care and family satisfaction, a sta ndard for the new era of healthcare delivery.