The implementation of clinical paths for six common urological procedures,and an analysis of variances

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.