Implementation of a clinical pathway decreases length of stay and hospital charges for patients undergoing total colectomy and ileal pouch/anal anastomosis. Discussion.
Clinical pathways are increasingly being used by hospitals to improve efficiency in the care of certain patient populations ; however little prospective data are available to support their use.
This study examined whether using a clinical pathway for patients undergoing ileal pouch/anal anasto-mosis, a complex procedure in which we had extensive practical experience, affected hospital charges or length of stay (LOS).
A clinical pathway was developed to serve patients undergoing elective total colectomy and ileal pouch/anal anastomosis.
All operations were performed by two attending physicians (J.F. E, M.S.N.). Before implementation, 10 pilot patients were prospectively monitored to ensure that hospital charges were accurately generated.
In addition, charge audits were performed by an outside agency to verify the accuracy of the hospital bills.
The pathway was then implemented, and 14 patients were prospectively analyzed.
In all patients the principal diagnosis was ulcerative colitis, with the exception of three patients with familial polyposis.
Mean external audit charges were within 2% of the hospital bills ; therefore the hospital bills were used in all calculations.
The mean LOS decreased from 10.3 days to 7.5 days (p=0.046) for patients on the pathway versus pilot patients.
Mean hospital charges also decreased significantly, from $21,650 to $17,958 per patient (p=0.005). (...)
Mots-clés Pascal : Proctocolectomie, Influence, Protocole thérapeutique, Programme thérapeutique, Temps, Hospitalisation, Coût, Etude comparative, Homme, Côlon, Rectum, Chirurgie, Appareil digestif pathologie, Intestin pathologie, Economie santé
Mots-clés Pascal anglais : Proctocolectomy, Influence, Therapeutic protocol, Therapeutic schedule, Time, Hospitalization, Costs, Comparative study, Human, Colon, Rectum, Surgery, Digestive diseases, Intestinal disease, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0543436
Code Inist : 002B30A04B. Création : 24/03/1998.