Pl. Chang et al., The implementation of clinical paths for six common urological procedures,and an analysis of variances, BJU INT, 84(6), 1999, pp. 604-609
Objective To evaluate the outcomes of treatment after implementing clinical
paths for six common urological procedures, and analyse the variances from
these paths.
Patients and methods The study comprised 1006 consecutive patients treated
according to the recommendations of the clinical path for six common urolog
ical procedures: the results of treatment were compared with those from 100
6 patients treated by the same physicians before implementing the clinical
paths. Total admission charges were divided into five categories, i.e. oper
ation and anaesthesia, laboratory, radiology, pharmacy and other. The diffe
rences in these fine categories before and after implementation were determ
ined: the variance data were also tracked and analysed. Five quality indica
tors were monitored during implementation and compared with the data before
implementation.
Results The mean length of hospital stay (LOS) and admission charges were s
ignificantly tower (P = 0.03 and P < 0.01) after implementation. The charge
s for laboratory, radiology, pharmacy and other were significantly decrease
d after the use of clinical paths. The common variations from the clinical
paths were patient-related variance (33%) and discharge variance (26%). Var
iances affecting the LOS only or the admission charge only were more common
than those affecting neither the LOS nor admission charges (both P < 0.01)
, or both (both P < 0.01). After implementation, the results of the ave qua
lity indicators were significantly improved and the number of patients with
surgical complications was significantly reduced (P < 0.01), but the morta
lity and readmission rate did not increase.
Conclusions The implementation of clinical paths for six common urological
procedures decreased the LOS, admission charges and surgical complications,
and improved the quality of care. During implementation, variances can aff
ect the LOS and/or admission charges.