<oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
  <dc:creator>Müller MK</dc:creator>
  <dc:creator>Dedes KJ</dc:creator>
  <dc:creator>Dindo D</dc:creator>
  <dc:creator>Steiner S</dc:creator>
  <dc:creator>Hahnloser D</dc:creator>
  <dc:creator>Clavien PA</dc:creator>
  <dc:date>2009</dc:date>
  <dc:description xmlns:ns0="xml" ns0:lang="en">BACKGROUND
One strategy to reduce the consumption of resources associated to specific procedures is to utilize clinical pathways, in which surgical care is standardized and preset by determination of perioperative in-hospital processes. The aim of this prospective study was to establish the impact of clinical pathways on costs, complication rates, and nursing activities.


METHOD
Data was prospectively collected for 171 consecutive patients undergoing laparoscopic cholecystectomy (n = 50), open herniorrhaphy (n = 56), and laparoscopic Roux-en-Y gastric bypass (n = 65).


RESULTS
Clinical pathways reduced the postoperative hospital stay by 28% from a mean of 6.1 to 4.4 days (p &lt; 0.001), while the 30-day readmission rate remained unchanged (0.5% vs. 0.45%). Total mean costs per case were reduced by 25% from euro 6,390 to euro 4,800 (p &lt; 0.001). Costs for diagnostic tests were reduced by 33% (p &lt; 0.001). Nursing hours decreased, reducing nursing costs by 24% from euro 1,810 to euro 1,374 (p &lt; 0.001). A trend was noted for lower postoperative complication rates in the clinical pathway group (7% vs. 14%, p = 0.07).


CONCLUSIONS
This study demonstrates clinically and economically relevant benefits for the utilization of clinical pathways with a reduction in use of all resource types, without any negative impact on the rate of complications or re-hospitalization.</dc:description>
  <dc:format>application/pdf</dc:format>
  <dc:identifier>https://sonar.ch/global/documents/148774</dc:identifier>
  <dc:language>eng</dc:language>
  <dc:relation>info:eu-repo/semantics/altIdentifier/doi/10.1007/s00423-008-0352-0</dc:relation>
  <dc:relation>info:eu-repo/semantics/altIdentifier/pmid/18521624</dc:relation>
  <dc:rights>info:eu-repo/semantics/openAccess</dc:rights>
  <dc:source>Langenbeck's archives of surgery. - 2009</dc:source>
  <dc:subject xmlns:ns1="xml" ns1:lang="en">Adult</dc:subject>
  <dc:subject xmlns:ns2="xml" ns2:lang="en">Cholecystectomy, Laparoscopic</dc:subject>
  <dc:subject xmlns:ns3="xml" ns3:lang="en">Cost Savings</dc:subject>
  <dc:subject xmlns:ns4="xml" ns4:lang="en">Cost-Benefit Analysis</dc:subject>
  <dc:subject xmlns:ns5="xml" ns5:lang="en">Critical Pathways</dc:subject>
  <dc:subject xmlns:ns6="xml" ns6:lang="en">Diagnostic Tests, Routine</dc:subject>
  <dc:subject xmlns:ns7="xml" ns7:lang="en">Female</dc:subject>
  <dc:subject xmlns:ns8="xml" ns8:lang="en">Gastric Bypass</dc:subject>
  <dc:subject xmlns:ns9="xml" ns9:lang="en">Health Care Costs</dc:subject>
  <dc:subject xmlns:ns10="xml" ns10:lang="en">Health Resources</dc:subject>
  <dc:subject xmlns:ns11="xml" ns11:lang="en">Hernia, Inguinal</dc:subject>
  <dc:subject xmlns:ns12="xml" ns12:lang="en">Hospital Costs</dc:subject>
  <dc:subject xmlns:ns13="xml" ns13:lang="en">Hospitals, Teaching</dc:subject>
  <dc:subject xmlns:ns14="xml" ns14:lang="en">Humans</dc:subject>
  <dc:subject xmlns:ns15="xml" ns15:lang="en">Laparoscopy</dc:subject>
  <dc:subject xmlns:ns16="xml" ns16:lang="en">Length of Stay</dc:subject>
  <dc:subject xmlns:ns17="xml" ns17:lang="en">Male</dc:subject>
  <dc:subject xmlns:ns18="xml" ns18:lang="en">Middle Aged</dc:subject>
  <dc:subject xmlns:ns19="xml" ns19:lang="en">National Health Programs</dc:subject>
  <dc:subject xmlns:ns20="xml" ns20:lang="en">Nursing Staff, Hospital</dc:subject>
  <dc:subject xmlns:ns21="xml" ns21:lang="en">Patient Readmission</dc:subject>
  <dc:subject xmlns:ns22="xml" ns22:lang="en">Pilot Projects</dc:subject>
  <dc:subject xmlns:ns23="xml" ns23:lang="en">Postoperative Complications</dc:subject>
  <dc:subject xmlns:ns24="xml" ns24:lang="en">Prospective Studies</dc:subject>
  <dc:subject xmlns:ns25="xml" ns25:lang="en">Switzerland</dc:subject>
  <dc:subject xmlns:ns26="xml" ns26:lang="en">Utilization Review</dc:subject>
  <dc:title xmlns:ns27="xml" ns27:lang="en">Impact of clinical pathways in surgery.</dc:title>
  <dc:type>http://purl.org/coar/resource_type/c_6501</dc:type>
</oai_dc:dc>