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Development and Implementation

James Cohen, MD, PhD; Mary Stock, RN, BSN; Peter Andersen, MD; Edwin Everts, MD

Arch Otolaryngol Head Neck Surg. 1997;123(1):11-14.

Abstract
Objective
To design, implement, and study the effectiveness of 4 new critical pathways relevant to head and neck oncological care.

Design
Before-after trial.

Setting
Tertiary referral academic institution.

Patients
Sixty-eight patients admitted for head and neck oncological surgery or chemotherapy from December 1, 1995, through May 31, 1996; 30 patients with similar diagnoses and who underwent surgical procedures from December 1, 1994, to December 1, 1995, who served as historical controls.

Interventions
Implementation of 4 critical pathways: chemotherapy, clean head and neck surgery, clean contaminated head and neck surgery, clean contaminated head and neck surgery with reconstructive flap.

Main Outcome Measures
Length of stay, cost of hospitalization, and variance tracking (deviations from established standards).

Results
The length of stay for the clean contaminated group without flap reconstruction decreased by 1.5 days, and costs decreased by $7407 per patient (P<.05, student t test). The length of stay decreased 1.6 days in the clean contaminated group with flap reconstruction, and costs decreased $9845 per patient (P<.05, Student t test). Nine patients (13%) experienced a prolonged length of stay while on a critical pathway.

Conclusions
Implementation of critical pathways has resulted in a decreased overall length of stay and cost of hospitalization. It has also allowed for better coordination and documentation of patient care, while the tracking of variances has simplified problem identification and correction.

Arch Otolaryngol Head Neck Surg. 1997;123:11-14

Author Affiliations
From the Department of Otolaryngology/Head and Neck Surgery, Oregon Health Sciences University, Portland.

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