Impact of a clinical pathway for elective infrarenal aortic reconstructions.

OBJECTIVE: To determine the impact of a clinical pathway for elective infrarenal aortic reconstruction on outcome, resource utilization, and cost in a university medical center. SUMMARY BACKGROUND DATA: Clinical pathways have been reported to control costs, reduce resource utilization, and maintain or improve the quality of patient care, although their use during elective aortic reconstructions remains unresolved. METHODS: A clinical pathway was developed for elective infrarenal aortic reconstructions by a multidisciplinary group comprised of representatives from each involved service. The prepathway practice and costs were analyzed and an efficient, cost-effective practice with specific outcome measures was defined. The impact of the pathway was determined by retrospective comparison of outcome, resource utilization, and cost (total and direct variable) between the pathway patients (PATH, n = 45) and a prepathway control group (PRE, n = 20). RESULTS: There were no significant differences in the patient demographics, comorbid conditions, operative indications, or type of reconstruction between the groups. There were no operative deaths and the overall complication rate (PRE, 35% vs. PATH, 34%) was similar. The pathway resulted in significant decreases in the total length of stay and preoperative length of stay and a trend toward a significant decrease (p = 0.08) in the intensive care length of stay for the admission during which the operation was performed. The pathway also resulted in significant decreases in both direct variable and total hospital costs for this admission, as well as a significant decrease in the overall direct variable and total hospital costs for the operative admission and the preoperative evaluation (< or =30 days before operative admission). Despite these reductions, the discharge disposition, 30-day readmissions, and number of postoperative clinic visits within 90 days of discharge were not different. CONCLUSIONS: Implementation of a clinical pathway for elective infrarenal aortic reconstructions dramatically decreased resource utilization and hospital costs without affecting the quality of patient care and did not appear to shift the costs to another setting.

Use of cryotherapy for orthopaedic patients.

Effective pain management and prevention of edema are goals for orthopaedic patients after injury and after surgery. Cryotherapy is the use of cold to decrease swelling and pain when tissue is damaged secondary to trauma or surgery. Although cryotherapy has been used for years by some practitioners to achieve these goals, it is gaining wider acceptance in sports medicine for acute and postoperative care. Newer techniques of application have broadened its use for postoperative care. This article reviews the physiology of cold, basic principles of cryotherapy, various techniques of cold application, nursing assessment and care, and patient teaching for a patient with cryotherapy.

The effect of familiar and unfamiliar voice treatments on intracranial pressure in head-injured patients.

Limited research has been conducted exploring the relationship between verbal stimulation and intracranial pressure (ICP). The purpose of this study was to investigate effects of verbal stimulation on ICP in head-injured patients. The sample consisted of 12 head-injured patients with a mean age of 31.5 years and mean Glasgow Coma Scale score of 7.8. A message was recorded by a familiar voice (family) and an unfamiliar voice (researcher). The familiar voice message was played to each subject. After a rest period, the unfamiliar voice message was played. ICP was recorded before, during and after playing both taped messages. Results demonstrated little change in ICP of head-injured patients when exposed to recorded verbal stimuli. Paired t-tests demonstrated no statistically significant differences between means. Results suggest families of head-injured patients with normal ICP can verbally interact with the patients for short periods without significant increases in ICP.