Using variance tracking to improve outcomes and reduce costs.

Clinical pathways outline patient-care delivery over time for specific patient populations, but their true utility is derived from information obtained through variance tracking-documenting when and why a patient's care varies from the clinical pathway. This article describes one health care facility's variance tracking for pulmonary, medical oncology, and nephrology patients and their associated measured outcomes. Avoidable hospital days were tracked and a performance improvement initiative, focused on the pathways most often used on the medical unit, was undertaken, resulting in decreased length of patient stay and cost savings of more than $160,000.