Clinical pathways improve hospital resource use in endocrine surgery.

BACKGROUND: Clinical pathways are increasingly adopted to streamline care after elective surgery. Here, we describe novel clinical pathways developed for endocrine operations (ie, unilateral thyroid lobectomy, total thyroidectomy, parathyroidectomy) and evaluate their effects on economic end points at a major academic hospital. STUDY DESIGN: Length of stay (LOS), hospital charges, and hospital costs for 681 patients undergoing elective endocrine surgery during a 30-month period were compared between patients managed with or without a specific pathway. Hospital costs were subcategorized by cost center. The analysis arms were conducted concurrently to control for institutional effects and end points were adjusted for demographic factors and comorbidity. RESULTS: Clinical pathways were observed to significantly reduce LOS, charges, and costs for endocrine procedures. LOS was reduced for thyroid lobectomy (nonpathway 1.6 days versus pathway 1.0; p < 0.001), total thyroidectomy (2.8 versus 1.1; p < 0.0001), and parathyroidectomy (1.6 versus 1.1; p < 0.001). Nonpathway patients were 6.2 times more likely to be admitted to the intensive care unit than pathway patients (p < 0.05). Clinical pathways reduced total charges from $21,941 to $17,313 for all cases (21% reduction; p < 0.0001), with 47% of savings attributable to reduced LOS. Significant improvements were observed for laboratory use (73% reduction; p < 0.0001) and nonroutine medication administration (73% reduction; p < 0.0001). The readmission rate within 72 hours of discharge was not significantly lower in the pathway group. CONCLUSIONS: Implementation of clinical pathways improves efficiency of care after elective endocrine surgery without adversely affecting safety or quality. Because these system measures optimize resource use, they represent an important component of high-volume subspecialty surgical services.

Implementation of an OR efficiency program.

Perioperative efficiency is considered a hallmark for physician and patient satisfaction. An OR efficiency program was implemented in a hospital in the northeastern United States in 2005. After one year, improvements were seen in OR schedule adherence, room turnover time, and staff member consistency across all shifts. A well-executed perioperative efficiency program may not only enhance physician and patient satisfaction, but also may improve staff satisfaction and patient safety.