Effect of a clinical pathway on selected clinical outcomes of pulmonary lobectomy

Abstract

Background: North American hospitals use clinical care pathways to reduce length of stay, readmissions, and resource utilization and also to increase patient satisfaction. This study examined the effects of clinical pathways after pulmonary lobectomy in Taiwanese patients.

Methods: During 1997, a multidisciplinary team developed a lobectomy clinical pathway. The Program Evaluation Review Technique was used to analyze variances from the clinical pathway. Based on these findings, a standardized clinical pathway was implemented in late 1997. Forty patients participated. The variables of the study are length of hospital stay, readmission rates, spirometry usage, patient education and costs benefited from clinical care pathway use.

Results: Fourteen lobectomy patients following the clinical pathway had a mean length of stay of 17.9+/-4.18 days (p < 0.001) and 0% readmission (p < 0.001). Without a pathway, 26 lobectomy patients had a mean length of stay of 37.5+/-6.18 days and 18% were readmitted. Factors affecting clinical pathway success were preoperative days(p < 0.001), postoperative days (p = 0.033), spirometry usage (p = 0.043) and patient education (p = 0.02). Clinical pathway use reduced mean hospital costs by 16% for lobectomy.

Conclusions: Length of hospital stay, readmission rates, spirometry usage, patient education and costs benefitted from clinical care pathway use. Factors critical to success appear to be multidisciplinary teamwork and communication.