Development and implementation of a clinical pathway for patients undergoing total laryngectomy - Impact on cost and quality of care

Background: The current health care climate demands the provision of qualit y patient care in a cost-effective manner. Clinical pathways define the ess ential components of care that are provided to patients with a specific dia gnosis to achieve a desired outcome within a predetermined period. Developm ent and implementation of clinical pathways streamline the provision of qua lity care in the most cost-effective manner. Objectives: To develop a clinical pathway for patients undergoing total lar yngectomy and to evaluate its impact on the cost and quality of care provid ed to these patients. Setting: A tertiary care academic medical center. Patients and Methods: A total of 45 patients were included in the study. Th e clinical pathway was implemented for 15 patients, while the other 30 pati ents were treated without the implementation of the pathway guidelines. Main Outcome Measures: Length of hospital stay, readmission rate, and hospi tal variable costs. Results: The clinical pathway affected all cost outcome measures. Length of stay decreased by 2.4 days (29%; P = .001), and the average hospital varia ble cost decreased from S3992 to $3419 per case. This represents a 14.4% re duction in cost associated with pathway implementation (P = .02). The stand ardization of care eliminated unnecessary variation and repetition in resou rce usage, resulting in overall cost reduction. Pathway implementation resu lted in a lower readmission rate (7% [1/15]) than that of patients treated prior to protocol implementation (23% [7/30]). Conclusion: Implementing a carefully developed clinical pathway may reduce cost without compromising the quality of care for patients undergoing total laryngectomy.