THE EFFECTS OF CLINICAL PATHWAYS FOR RENAL-TRANSPLANT ON PATIENT OUTCOMES AND LENGTH OF STAY

OBJECTIVES. Clinical pathways have been implemented nationwide but lit tle is understood about their effects on efficiency of care and patien t outcomes. The present study examined the effects of both development and implementation of two renal transplant pathways. METHODS. Cohorts of patients at a university hospital were compared before, during, an d after the development and implementation of two renal transplant cli nical pathways: isolated renal transplant from cadaveric donors (n = 1 70) or from living donors (n = 178). Clinical pathways for cadaveric a nd living related donor renal transplants were developed and implement ed. Hospital length of stay and complications and infections after ren al transplant were determined. RESULTS. Mean length of hospital stay d ecreased after development and implementation of the cadaveric donor p athway (11.8 days after implementation versus 17.5 days before develop ment). Cadaveric kidney recipients also had statistically fewer compli cations and infections after both guideline development and guideline implementation (57.1% before, 24.5% during, 18.5% after), but the grea test effect occurred during development. All of these findings persist ed after control for demographic and comorbid factors. There were no c hanges in hospital stay, complications, or infections in the patients who received kidneys from living donors. CONCLUSIONS. The development and use of a clinical pathway for cadaveric donor renal transplant pat ients was associated with a significant decline in length of stay, com plications, and infections, but much of the effect was seen during dev elopment rather than during implementation, and a closely related path way for living related donor patients had no effect. Further understan ding of what factors predict an effective pathway and what elements (i e, development or implementation) have an effect should be undertaken.