Implementation of a clinical pathway decreases length of stay and cost for bowel resection

Abstract

Objective: To examine the effect of a clinical pathway for small and large bowel resection on cost and length of hospital stay.

Summary background data: Clinical pathways are designed to streamline patient care delivery and maximize efficiency while minimizing cost. Theoretically, they should be most effective in commonly performed procedures, in which volume and familiarity are high.

Methods: A clinical pathway to assist in the management of patients undergoing bowel resection was developed by a multidisciplinary team and implemented. Data about length of stay and cost was collected for all patients undergoing bowel resection 1 year before and 1 year after pathway implementation. Three groups were compared: patients undergoing bowel resection in the year prior to pathway implementation (prepathway), patients in the year after pathway implementation but not included on the pathway (nonpathway), and patients included in the pathway (pathway).

Results: The mean cost per hospital stay was $19,997.35 +/- 1244.61 for patients in the prepathway group, $20,835.28 +/- 2286.26 for those in the nonpathway group, and $13,908.53 +/- 1113.01 for those in the pathway group (p < 0.05 vs. other groups). Mean postoperative length of stay was 9.98 +/- 0.62 days (prepathway), 9.68 +/- 0.88 days for (nonpathway), and 7.71 +/- 0.37 days (pathway) (p < 0.05 vs. other groups).

Conclusions: Implementation of the pathway produced significant decreases in length of stay and cost in the pathway group as compared to the prepathway group. These results support the further development of clinical pathways for general surgical procedures.

Figure 1. Length of stay by group. Figures are mean hospital days ± SEM. * Statistically significant vs. prepathway group by Student t test (p < 0.05). † Statistically significant vs. prepathway and nonpathway groups by ANOVA confirmed by Duncan test (p < 0.05). ‡ Statistically significant vs. prepathway group by ANOVA confirmed by Duncan test (p < 0.05). There were no significant differences in preoperative hospital stay between the groups.

Figure 2. Hospital costs by group. Figures are mean cost ± SEM in 1995 dollars. * Statistically significant vs. prepathway and nonpathway groups by ANOVA confirmed by Duncan test (p < 0.05). There was no statistically significant difference between prepathway and postpathway groups (p = 0.055 by Student t test).