Results of a clinical care pathway for radical prostatectomy patients in an open hospital-multiphysician system

Objectives: The object of this study was to evaluate the results of a compr ehensive clinical care pathway (CCP) aimed at reducing the length of hospit alization and overall cost for patients undergoing radical prostatectomy in a setting including both academic and private physicians. Methods:The clin ical records of 1,129 consecutive patients who underwent radical prostatect omy by 24 urologists between July 1, 1990, and December 31, 1996, were revi ewed. The factors considered were length of stay, morbidity and mortality, readmission rates, and average cost, The CCP was implemented on January 1, 1994. Its scope was to minimize preoperative evaluation, eliminate the preo perative hospital stay, standardize postoperative care and provide intensiv e patient education. Results: The average length of stay decreased signific antly after implementation of the CCP (8.1 vs. 4.9 days, p = 0.0001). In 19 90, there was a large difference in length of stay between academic and pri vate physicians (8.3 vs. 12.6 days) (p = 0.02) but by 1 year after implemen tation of the CCP there was virtually no difference (4.69 vs. 4.71 days) (p > 0.05). Complication rates were similar before and after implementation o f the CCP. Using the average 1993 cost/case as the baseline preCCP figure, the average cost of radical prostatectomy decreased by 16% in 1994 and by 2 2% in 1995. Conclusions: It is possible to successfully implement a CCP in a multi-physician system to reduce length of stay and cost of radical prost atectomy without subjecting the patient to a greater risk of complication.