CLINICAL BENCHMARKING IMPROVES CLINICAL PATHS - EXPERIENCE WITH CORONARY-ARTERY BYPASS-GRAFTING

Background: Clinical paths and clinical benchmarking are consistent wi th, and readily adaptable to, any health care organization that espous es the principles of continuous quality improvement. Clinical pathway: In its initial clinical path project, Borgess Medical Center analyzed and streamlined the processes of caring for a coronary artery bypass graft (CABG) patient. Team discussions were driven by comparative data , specialty guidelines, peer review organization guidelines, patient f inancial statements, patient records, and the applicable literature. O ne year after the CABG clinical paths were implemented, average total charges to the patient dropped from $35,700 to $32,700. Average length of stay also dropped, from 11.1 to 9.7 days. The mortality rate held stable at 2.7%. Clinical benchmarking: Recognizing the opportunity to further improve its CABG clinical path, Borgess participated in MediQu al's CABG benchmarking project. The team followed MediQual's five phas es of clinical benchmarking: focus and opportunity assessment, outcome analysis and comparison, clinical process documentation, benchmark pr ocess comparison, and action planning, implementation, and monitoring. Using benchmark data provided by MediQual, the CABG benchmark team fo cused on the high-risk population and identified further opportunities for streamlining the CABG clinical pathway. Several areas for improve ment were identified by comparing Borgess's practices to the benchmark hospitals. Conclusion: Developing a clinical path before beginning to benchmark ''forced'' Borgess Medical Center to develop a clear unders tanding of its own processes. This allowed the benchmark team to easil y identify variances between its CABG processes and those of the bench mark hospitals and to select which variations the hospital should adop t.