The implementation of clinical paths for six common urological procedures, and an analysis of variances

Objective. To evaluate the outcomes of treatment after implementing clinical paths for six common urological procedures, and analyse the variances from these paths. Patients and methods. The study comprised 1006 consecutive patients treated according to the recommendations of the clinical path for six common urological procedures: the results of treatment were compared with those from 1006 patients treated by the same physicians before implementing the clinical paths. Total admission charges were divided into five categories, i.e. operation and anaesthesia, laboratory, radiology, pharmacy and other. The differences in these five categories before and after implementation were determined; the variance data were also tracked and analysed. Five quality indicators were monitored during implementation and compared with the data before implementation. Results. The mean length of hospital stay (LOS) and admission charges were significantly lower (P = 0.03 and P < 0.01) after implementation. The charges for laboratory, radiology, pharmacy and other were significantly decreased after the use of clinical paths. The common variations from the clinical paths were patient-related variance (33%) and discharge variance (26%). Variances affecting the LOS only or the admission charge only were more common than those affecting neither the LOS nor admission charges (both P < 0.01), or both (both P < 0.01). After implementation, the results of the five quality indicators were significantly improved and the number of patients with surgical complications was significantly reduced (P < 0.01), but the mortality and readmission rate did not increase. Conclusions. The implementation of clinical paths for six common urological procedures decreased the LOS, admission charges and surgical complications, and improved the quality of care. During implementation, variances can affect the LOS and/or admission charges.