BENCHMARKING THE PERIOPERATIVE PROCESS - II - INTRODUCING ANESTHESIA CLINICAL PATHWAYS TO IMPROVE PROCESSES AND OUTCOMES AND TO REDUCE NURSING LABOR INTENSITY IN AMBULATORY ORTHOPEDIC-SURGERY

Study Objectives: (1) To introduce anesthesia clinical pathways as a m anagement tool to improve the quality of care; (2) to use the Procedur al Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as a template for data collection and analysis; and ( 3) to determine the effects of anesthesia clinical pathways on surgica l processes, outcomes, and costs in common ambulatory orthopedic surge ry. Design: Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) d uring academic years (AY) 1995-1996 and 1996-1997. Patient data from A Y 1995-1996, during which no intraoperative anesthesia clinical pathwa ys existed, served as historical controls. Data from AY 1996-1997, dur ing which intraoperative anesthesia clinical pathways were used, serve d as the treatment group. Regional anesthesia options were routinely o ffered to patients in the clinical pathway. Setting: Ambulatory surger y center in a teaching hospital. Measurements and Main Results: The re cords of 503 ASA physical status I and LI patients were reviewed. 1996 -1997 patients underwent clinical pathway anesthesia care in which the intraoperative and postoperative anesthesia process was standardized with respect to symptom management, drugs, and equipment used. 1995-19 96 patients did not have a standardized intraoperative and postoperati ve anesthetic course with respect to the management of common symptoms or to specific drugs and supplies used. Intervals described in the AA CD Procedural Times Glossary, anesthesia drug and supply costs, and pa tient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by the use of the anesthesia clinical pathway, were measured. Clinical pathway anesthesia care for ACLR in 1996-1997, which actively incorporated regional anesthesia op tions, reduced pharmacy and materials cost variability; slightly incre ased turnover time; improved intraoperative anesthesia and surgical ef ficiency, recovery times, and unexpected admission rates; and decrease d the number of required nursing interventions for common postoperativ e symptoms. Conclusions: Clinical pathway patient management systems i n anesthesia care are likely to produce useful outcome data of current practice patterns when compared with historical controls. This manage ment tool may be useful in simultaneously containing costs and improvi ng process efficiency and patient outcomes. (C) 1998 by Elsevier Scien ce Inc.