Effects of implementation of 18 clinical pathways on costs and quality of care among patients undergoing urological surgery

Purpose: We evaluated the effects on the costs and quality of care of imple mentation of 18 clinical pathways for urological operations. Materials and Methods: From April 1997 to March 1998 patients undergoing 1 of 18 urological operations were treated according to clinical pathways. Th e outcomes in terms of length of hospital stay and admission charges of the se patients were compared with those of patients treated between April 1996 and March 1997 before clinical pathways were implemented. We also selected 7 clinically relevant quality indicators to assess the quality of care bef ore and after clinical pathway implementation. Results: Of the 1,784 patients undergoing urological surgery from April 199 7 to March 1998, 1,382 (77.5%) were treated according to 1 of the 18 clinic al pathways. Before implementation 1,279 of 1,615 patients (79.2%) underwen t these procedures. The length of hospital stay decreased from 5.5 to 4.9 d ays (p <0.01) and the average hospital admission charges decreased by 12.9% (p <0.01) after implementation. Five of the quality indicators, including the rate of surgical complications, were significantly improved after pathw ay implementation. The hospitalization rate was not affected (1.3 before ve rsus 0.8% after implementation, p = 0.18). Variations from the clinical pat hways occurred in 543 cases (39.3%) and affected the length of hospital sta y only (11.6%) or the admission charge only (12.9%) more often than both (7 .8%, p <0.01) or neither (7.0%, p <0.01). The most common variances in thes e patients were patient related (30.8%), Conclusions: Implementation of multiple clinical pathways in a urology depa rtment can improve urological practice by decreasing the length of hospital stay, admission charges and rate of surgical complications, and by improvi ng the quality of care.