PULMONARY LOBECTOMY PATIENT-CARE PATHWAY - A MODEL TO CONTROL COST AND MAINTAIN QUALITY

Background. Cost containment is a reality in thoracic surgery. Patient care pathways have proved effective in cardiac surgery to reduce leng th of stay and control costs. Methods. A multidisciplinary team formul ated a pulmonary lobectomy patient care pathway to standardize care, r educe length of stay and costs, and maintain quality. Variance codes w ere developed to collect data prospectively on reasons for prolonged s tay. A patient satisfaction survey was instituted to learn patients' r esponses to their hospitalization. Results. One hundred forty-seven pa tients underwent lobectomy in 1995 before institution of the pathway w ith a mean length of stay of 10.6 days and a mean cost of $16,063. The lobectomy pathway was instituted at the beginning of 1996. One hundre d thirty patients underwent lobectomy in 1996 with a mean length of st ay of 7.5 days (p = 0.03) and a mean cost of $14,792 (p = 0.47). Readm ission and mortality rates were unchanged. Eighty-eight of 130 patient s (68%) were able to be discharged by the target length of stay of 7 d ays in 1996 as opposed to 76 of 147 patients (52%) in 1995. The most c ommon reason for delayed discharge was inadequate pain control. The ma jority of patients felt prepared for discharge by the seventh postoper ative day (70 of 96 patients, 73%). Conclusions. The institution of a lobectomy patient care pathway appeared to reduce length of stay and c osts. The pathway provided a framework to begin systematic quality con trol measures to enhance patient care. (C) 1997 by The Society of Thor acic Surgeons.