The effect of clinical pathway implementation on total hospital costs for thyroidectomy and parathyroidectomy patients

Clinical pathways have long been used to guide the delivery of patient care in varied practice settings. There is little information in the literature to document the effectiveness of pathway implementation in general surgica l populations. This study reports the effect of clinical pathway implementa tion in two general surgical patient groups, thyroidectomy and parathyroide ctomy. Clinical pathways were implemented to serve patients undergoing thyr oidectomy and parathyroidectomy surgery. The effects of both clinical pathw ays on total hospital costs, length of hospitalization, variances, and outc omes were collected and evaluated from July 1998 through July 1999. These d ata were compared to data from the previous year. The average length of sta y for parathyroidectomy patients decreased from 2.4 to 1.5 days (P = 0.26) for pathway patients as compared to prepathway patients. The average cost p er case decreased from $5071 to $4291 (P = 0.50) for parathyroidectomy path way versus prepathway patients. The average length of stay decrease for thy roidectomy patients was 1.4 to 1.2 (P = 0.16) for the pathway to prepathway comparison. The average cost per case decrease was minor at $4117 to $4111 . Pharmacy costs and laboratory utilization were effectively reduced. Perio perative costs rose dramatically during this period, operating room/central sterile supply cost per case rose 12 per cent, anesthesia supply cost per case rose 15 per cent, and surgical pathology costs increased 110 per cent overall for both patient groups. Clinical pathway implementation has allowe d us to reduce or maintain total hospital costs in the face of rising perio perative costs. We conclude that implementation of these clinical pathways has allowed us to improve consistency with which we deliver care while main taining the quality of patient outcomes and reducing the costs of care and length of hospital stay.