Department of Gynecology, Interdisciplinary Breast Center, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
Arch Gynecol Obstet. 2012 Feb;285(2):515-20. doi: 10.1007/s00404-011-1994-7. Epub 2011 Jul 21.
The aim of the present study is to evaluate the effects of the implementation of clinical pathways into routine practice of breast surgery.
We implemented a clinical pathway for breast surgery in 2006 and analysed for the following 3 years its path in respect to hospital stay, total costs per case, readmission rate, and patients' satisfaction.
The mean hospital stay decreased significantly from 4.5 days in 2006 to 3.7 days in 2007 and revealed 3.4 days in 2008. This is a decrease by 24.4% for the duration of hospital stay. The total cost per case between 2006 and 2007 showed a significant decrease of 23.4%. The total costs increased by 13.4% in 2008. Readmission rate was under 5% and remained constant. Patients' satisfaction remained constant, whereby more than 90% of the expected good results were attained.
There is substantial evidence that clinical pathways lead to various improvements in clinical care in surgery. We show a constantly significant effect on duration of hospital stay without any increase in the number of readmissions. In our view, it is not only an economic benefit which prevails here, but also especially a transparency of treatment which leads to higher compliance, better outcome and a shorter length of stay.
本研究旨在评估将临床路径纳入常规乳腺外科实践的效果。
我们于 2006 年实施了乳腺外科临床路径，并在接下来的 3 年中分析了其在住院时间、每个病例的总费用、再入院率和患者满意度方面的情况。
住院时间从 2006 年的 4.5 天显著缩短至 2007 年的 3.7 天，2008 年进一步缩短至 3.4 天。这意味着住院时间缩短了 24.4%。2006 年至 2007 年每个病例的总费用显著下降了 23.4%。2008 年总费用增加了 13.4%。再入院率低于 5%且保持稳定。患者满意度保持稳定，超过 90%的患者达到了预期的良好效果。
有大量证据表明，临床路径可改善外科临床护理的各个方面。我们发现，住院时间持续显著缩短，而再入院率没有增加。在我们看来，这不仅带来了经济效益，还提高了治疗的透明度，从而提高了患者的依从性、改善了治疗效果并缩短了住院时间。
