scholarly journals Outcomes of a Clinical Pathway for Pleural Disease Management: “Pleural Pathway”

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Srinivas R. Mummadi ◽  
Peter Y. Hahn
Keyword(s):  
Length Of Stay ◽  
Clinical Pathway ◽  
Average Length ◽  
Clinical Pathways ◽  
Administrative Database ◽  
British Thoracic Society ◽  
Pleural Disease ◽  
Average Case ◽  
Community Healthcare ◽  
Pleural Diseases

Background and Objectives. Clinical pathways are evidence based multidisciplinary team approaches to optimize patient care. Pleural diseases are common and accounted for 3.4 billion US $ in 2014 US inpatient aggregate charges (HCUPnet data). An institutional clinical pathway (“pleural pathway”) was implemented in conjunction with a dedicated pleural service. Design, implementation, and outcomes of the pleural pathway (from August 1, 2014, to July 31, 2015) in comparison to a previous era (from August 1, 2013, to July 31, 2014) are described. Methods. Tuality Healthcare is a 215-bed community healthcare system in Hillsboro, OR, USA. With the objective of standardizing pleural disease care, locally adapted British Thoracic Society guidelines and a centralized pleural service were implemented in the “pathway” era. System-wide consensus regarding institutional guidelines for care of pleural disease was achieved. Preimplementation activities included training, acquisition of ultrasound equipment, and system-wide education. An audit database was set up with the intent of prospective audits. An administrative database was used for harvesting outcomes data and comparing them with the “prior to pathway” era. Results. 54 unique consults were performed. A total of 55 ultrasound examinations and 60 pleural procedures were performed. All-cause inpatient pleural admissions were lower in the “pathway” era (n=9) compared to the “prior to pathway” era (n=17). Gains in average case charges (21,737$ versus 18,818.2$/case) and average length of stay (3.65 versus 2.78 days/case) were seen in the “pathway” era. Conclusion. A “pleural pathway” and a centralized pleural service are associated with reduction in case charges, inpatient admissions, and length of stay for pleural conditions.

scholarly journals Penerapan Clinical Pathways sebagai Instrumen Pengendalian Biaya Pelayanan : Studi Penelitian Tindakan Penderita BPJS yang Menjalani Operasi Caesar dengan Sistem Pembayaran INA-CBG

2021 ◽  
Vol 4 (2) ◽  
pp. 593-599
Author(s):  
Annisa Fitria ◽  
Andri Sofa Armani ◽  
Thinni Nurul Rochmah ◽  
Bangun Trapsila Purwaka ◽  
Widodo Jatim Pudjirahardjo
Keyword(s):  
Action Research ◽  
Caesarean Section ◽  
Length Of Stay ◽  
Cesarean Section ◽  
Clinical Pathway ◽  
Average Length ◽  
Clinical Pathways ◽  
Hospital Costs ◽  
Average Length Of Stay ◽  
Length Of Hospitalization

This study aims to determine the effect of using clinical pathways to control total actual hospital costs for BPJS patients who undergo a cesarean section. The method used in this research is action research. The results showed that the average actual hospital costs were significantly higher after the application of CP with p = 0.019. The average length of stay, service costs, and hospital costs were significantly lower in the entire CP form group with p = 0.012, p = 0.013, and p = 0.012. In conclusion, this study shows that the application of clinical pathways can reduce the length of hospitalization and actual hospital costs for cesarean section patients and indicates that clinical pathways can make services more efficient.   Keywords: Hospital Costs, Clinical Pathway, Caesarean Section

scholarly journals IMPACT OF CLINICAL PATHWAYS COMPLIANCE FOR REDUCING LENGTH OF STAY

2020 ◽  
Vol 8 (1) ◽  
pp. 79
Author(s):  
Michael Siswanto ◽  
Djazuly Chalidyanto
Keyword(s):  
Length Of Stay ◽  
Clinical Pathway ◽  
Acute Gastroenteritis ◽  
Pediatric Patients ◽  
Average Length ◽  
Clinical Pathways ◽  
Multidisciplinary Care ◽  
Care Plan ◽  
Cross Sectional ◽  
Therapy Compliance

Background: Clinical pathway is multidisciplinary care plan based on the best clinical practice for a group of patients with a particular diagnosis, designed to minimize care delay as well as maximize the quality of care and clinical outcomes. In 2017, average length of stay for pediatric patient with acute gastroenteritis was prolonged even clinical pathways had been implemented.Aim: Thid study determined the diagnostic examination and therapy compliance of clinical pathway related to the length of stay.Method: This study was cross sectional research through simple random sampling. Researchers analyzed pediatric patients whose clinical pathway were filled completely by doctors. The inclusion criteria were pediatric patients, admitted to hospitals during January to December 2018 as acute gastroenteritis patients. The data were analyzed using multiple classification analysis.Results: There were 197 patients with clinical pathway filled completely. As much as 60.91% of cases were compiled for diagnostic examination and 88.32% for therapy. There was no statistically significant correlation between diagnostic examination compliance (p > 0.05) and therapy compliance (p > 0.05) of clinical pathway with patients’ length of stay (combined = p > 0.05).Conclusion: Many factors could be related with the length of stay especially patients’ condition itself. In this study, clinical pathway compliance has no impact in reducing length of stay. Keywords: clinical pathway, compliance, length of stay, pediatric. 

scholarly journals INFLUENCE OF NURSING CLINICAL PATHWAY IMPLEMENTATION TO LENGTH OF STAY OF NON HEMORRHAGIC STROKE PATIENTS IN BUKITTINGGI ACHMAD MOCHTAR HOSPITAL

2018 ◽  
Vol 12 (1) ◽  
pp. 9
Author(s):  
Fitrianola Rezkiki
Keyword(s):  
Length Of Stay ◽  
Nursing Care ◽  
Clinical Pathway ◽  
Hemorrhagic Stroke ◽  
Average Length ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Stroke Patients ◽  
Nursing Clinical

<p><em>Lenght of stay is indicator of serving quality and nursing care to measure hospital efficiency level. Neurology ward is one of the wards that experience increasing of length of stay from 5,91 to 7,38. The cause of length of stay increasing is nursing care management that according to Calhoun can be formulated to nursing clinical pathway. The purpose of this study is to analyze influence of nursing clinical pathway implementation to length of stay of non hemorrhagic stroke patients in neurology ward Bukitttinggi Achmad Mochtar Hospital. The designs of this study used non-equivalent post test only control group design approach. Sample of this study were taken by purposive sampling with total of 32 samples consist of 16 sample as intervention group and another 16 samples as control group. Data analyzing used t-test independent. The result shows that there is significant influence for average length of stay of stroke non hemorrhagic patients that were given nursing clinical pathway compared to the group that is not given nursing clinical pathway with p value 0,001 (p value ≤ 0,05. According to this study, hospital should implement nursing clinical pathway when doing nursing care to patients in ward and also hospital should make policy related to nursing clinical payhway implementation..</em></p><p><em> </em></p>

MINI-SUMMARIES FROM THE U.K. HTA PROGRAMME

2001 ◽  
Vol 17 (2) ◽  
pp. 261-266
Keyword(s):  
Hip Fracture ◽  
Length Of Stay ◽  
Average Length ◽  
Clinical Pathways ◽  
Length Of Hospital Stay ◽  
Cost Effective ◽  
The United States ◽  
Local Conditions ◽  
Orthopedic Rehabilitation ◽  
The Impact

SUMMARY POINTS[bull ] Geriatric service interventions after hip fracture are complex and strongly influenced by local conditions. The effectiveness of rehabilitation programs is uncertain, and comparative studies comparing different treatments and strategies are of poor to moderate quality.[bull ] Based on the available evidence, geriatric hip fracture and early supported discharge programs are probably cost-effective since they appear to shorten the average length of hospital stay and are associated with significantly increased rates of return to previous residential status. Clinical pathways also appear to reduce total length of stay in hospital.[bull ] Geriatric orthopedic rehabilitation units are unlikely to be cost-effective, but some frailer patients may benefit in respect of reduced readmission rates and need for nursing home placement.[bull ] Length of stay may be reduced by the introduction of prospective payment systems, but these have led to increased use of nursing homes in the United States.[bull ] There is no evidence that any of the programs evaluated are associated with changes in mortality. However, there are insufficient data to assess the impact of any program on level of function, morbidity, quality of life, or impact on carers.

scholarly journals Efektifitas Implementasi Clinical Pathway Terhadap Average Length Of Stay dan Outcomes Pasien DF-DHF Anak di RSUD Kota Yogyakarta

2018 ◽  
Vol 2 (2) ◽  
pp. 175
Author(s):  
Neri Faradina Nur Fadilah ◽  
Savitri Citra Budi
Keyword(s):  
Length Of Stay ◽  
Clinical Pathway ◽  
Average Length ◽  
P Value ◽  
Cross Sectional ◽  
Average Length Of Stay

Latar belakang: Clinical pathway digunakan sebagai kendali mutu dan biaya dalam pelayanan kesehatan. Mutu pelayanan salah satunya dapat dilihat dari average length of stay dan outcomes. Implementasi clinical pathway yang sudah diterapkan perlu diukur efektifitasnya dalam menurunkan rata-rata lama dirawat dan menghasilkan outcomes yang lebih baik. Kasus DF dan DHF masuk dalam daftar 10 besar penyakit rawat inap di RSUD Kota Yogyakarta.Tujuan: Mengukur perbedaan average length of stay dan outcomes pasien DF-DHF anak antara sebelum dan setelah implementasi clinical pathway di RSUD Kota Yogyakarta.Metode: Jenis penelitian ini adalah penelitian kuantitatif dengan metode survey analitik dan rancangan cross sectional. Pengumpulan data dilakukan dengan studi dokumentasi pada 146 berkas rekam medis dan formulir clinical pathway.Hasil: Persentase outcomes tertinggi pada pasien DF yaitu pada kategori membaik 71,4% sebelum CP dan 80,9% setelah CP. Persentase outcomes tertinggi pada pasien DHF yaitu pada kategori membaik 83,9% sebelum CP dan 90,3% setelah CP. Average length of stay setelah CP lebih kecil dibandingkan sebelum CP pada pasien DF-DHF anak, dengan p-value DF anak = 0,016 < α = 0,05 dan p-value DHF anak = 0,021 < α = 0,05. Tidak ada perbedaan outcomes pasien DF-DHF anak antara sebelum dan setelah implementasi clinical pathway, dengan p_value DF anak = 0,775 > α = 0,05 dan p-value DHF anak = 1 > α = 0,05.Kesimpulan: Implementasi clinical pathway dapat menurunkan average length of stay, namun belum mampu membuktikan adanya perbedaan pada outcomes pasien.

scholarly journals Analysis of Cesarean Section Clinical Pathway Compliance at a Private Hospital in Yogyakarta

2019 ◽  
Vol 9 (1) ◽  
pp. 38
Author(s):  
Beta Haninditya ◽  
Tri Murti Andayani ◽  
Nanang Munif Yasin
Keyword(s):  
Length Of Stay ◽  
Cesarean Section ◽  
Pain Intensity ◽  
Clinical Pathway ◽  
Private Hospital ◽  
Clinical Pathways ◽  
P Value ◽  
Type C ◽  
The Relationship ◽  
Real Costs

This study aims to analyze the relationship between the compliance with the implementation of clinical pathways to therapeutic outcomes (ILO events, length of stay, pain intensity) and the total real cost of cesarean section patients. The study was conducted at a type C private hospital in Yogyakarta. This study is a non-experimental analytical study (observational analytic) with a cross sectional design using a retrospective data collection method and analyzed using Chi square test and non parametric regression test. Descriptive analysis for compliance with the implementation of clinical pathways was carried out by assessing the compliance of each care point contained in the clinical pathway section of the cesarean consisting of 12 points of care and will be grouped into two categories namely low compliance category with the average compliance value for clinical pathway <85% and good compliance with the average compliance value for clinical pathway ≥85%. Descriptions of adherence to the implementation of clinical pathway cesarean section each patient showed that as many as 686 patients (98%) had a good average compliance score and 14 patients (2%) had a low average compliance score. Outcome description 700 patients with cesarean section were found 1 patient experienced ILO, LOS according to clinical pathway (≤3 days) as many as 620 patients and 700 patients with pain scale ≤3. The results of the analysis of the relationship between the compliance and the implementation of the clinical pathway to the outcome of therapy (ILO events, length of stay, and pain intensity) showed the existence of a compliance relationship to the implementation of the clinical pathway with a value of p<0.05. The analysis of the relationship between the compliance to the implementation of the clinical pathway and the total real costs shows the relationship between the compliance   with   the   implementation   of  the  caesarean  section  clinical  pathway  at  a  type  C  private hospitals in Yogyakarta with the total real costs with p value of 0,000 and r value of 0.014.

scholarly journals Analisa Biaya Pengobatan Demam Tifoid Berdasarkan Clinical Pathway Di Rumah Sakit Harapan Bunda

2019 ◽  
Vol 13 (2) ◽  
Author(s):  
Pieter Hazmen ◽  
Shirly Kumala ◽  
Prih Sarnianto
Keyword(s):  
Length Of Stay ◽  
Typhoid Fever ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
High Volume ◽  
Antibiotic Use ◽  
Observational Research ◽  
Cost Of Treatment ◽  
Significant Difference ◽  
The Cost

Clinical pathways are used in quality and cost control with indicators of length of stay. Cases of typhoid fever at Harapan Bunda Hospital include the criteria for the first rank of High Volume in 2018 and Problem Prone in the cost of treatment. The purpose of the study is to analyze the cost of treatment based on the implementation of clinical pathways in antibiotic therapy. Observational research with comparative studies of the use of injection antibiotics based on clinical pathway implementation. Retrospective data collection with dependent outcome therapy variables (cost and length of stay) while the independent variable regimen of antibiotic use. The population of typhoid fever patients according to the criteria for the implementation of clinical pathway ICD code (A0.10) 571 patients. Samples using total sampling that fulfills the criteria of direct inclusion are made into samples divided by the antibiotic regimen of the payment system, the group with the least amount excluded. There were 4 observation groups: generic ceftriaxone (n = 52) branded ceftriaxone (n = 51), generic cefotaxime (n = 53) and branded cefotaxime (n = 57) totaling 213 patients. Satatistic test results of length of stay (p> 0.05) explained that they did not have a significant difference, the average value (5.1596). Medical expenses for generic cefotaxime (Rp 4,072,002,6792), generic cherryax (Rp 4,479,480,4808), branded cefotaxime (Rp 6,945,258,3333) and branded ceftriaxone (Rp 7,296,933,5686). Conclusions based on JKN (AMiB) antibiotic payment systems are cheaper than general and the cheapest cefotaxime cheapest generic antibiotics.

The Use and Modification of Clinical Pathways to Achieve Specific Outcomes in Bariatric Surgery

2005 ◽  
Vol 71 (2) ◽  
pp. 152-154 ◽  
Author(s):  
Melania Yeats ◽  
Sue Wedergren ◽  
Nicole Fox ◽  
Jon S. Thompson
Keyword(s):  
Bariatric Surgery ◽  
Length Of Stay ◽  
Patient Care ◽  
Clinical Pathway ◽  
Operative Time ◽  
Clinical Pathways ◽  
Complication Rates ◽  
Group Iii ◽  
Group I ◽  
Nasogastric Decompression

Clinical pathways are promoted for standardizing patient care and decreasing resource use without compromising outcome. Once established, we hypothesized that clinical pathways can then be used to modify patient care to achieve specific goals. Our aim was to evaluate a clinical pathway for the bariatric surgical patient that was initially designed to standardize care and later altered to modify the postoperative course. We retrospectively reviewed 150 consecutive patients undergoing open gastric bypass by a single surgeon. The first 50 patients were managed without a formal pathway, (group I). The next 50 were managed with a pathway that standardized care in order to reduce length of stay (LOS), (group II). For the final 50 patients, the pathway was modified to shorten nasogastric decompression time (group III). Patient information, blood loss (EBL), operative time, length of stay (LOS), nasogastric decompression, 30-day complication rates, and early readmissions were reviewed. The groups were similar with respect to gender, age, body mass index, American Society of Anesthesiologists (ASA) classification, and EBL. Operative time was significantly less in groups II and III compared to group I (82% and 68% vs. 38% <180 minutes, P < 0.05). LOS was shorter in groups II and III compared to group I (62% and 42% vs. 20% with a 4-day LOS, P < 0.05). Duration of nasogastric tube decompression was successfully decreased in group III when compared to groups I and II (76% vs. 14% and 6% 1 day or less, P < 0.05). Complication rates were significantly lower in group III as well (14% vs. 36% and 28%, P < 0.05). Standardizing patient care with a clinical pathway decreases LOS after bariatric surgery. An established clinical pathway can then be used to further modify patient care in order to achieve specific goals, such as shortened time of nasogastric decompression. This goal was accomplished without compromising patient outcome.

Changing practice patterns for children with heart disease: a clinical pathway approach

1998 ◽  
Vol 7 (2) ◽  
pp. 101-105 ◽  
Author(s):  
K Uzark ◽  
C Frederick ◽  
JJ Lamberti ◽  
HM Worthen ◽  
MT Ogino ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Ventricular Septal Defect ◽  
Tetralogy Of Fallot ◽  
Surgical Procedures ◽  
Clinical Pathway ◽  
Septal Defect ◽  
Practice Patterns ◽  
Clinical Pathways ◽  
Cardiac Surgical Procedures

BACKGROUND: Pediatric cardiac care is costly and requires extensive resources. We studied the effect of clinical pathways on practice patterns and patient care outcomes in infants and children hospitalized for cardiac surgery. METHODS: In consecutive patients admitted for selected cardiac surgical procedures before (n = 69) and after (n = 173) implementation of clinical pathways, outcomes including hospital length of stay, days in the ICU, time to extubation, ordering of blood studies, costs, and readmissions were compared. Data were analyzed for each of five cardiac surgical procedures: repair of an atrial septal defect, repair of a ventricular septal defect, division of a patent ductus arteriosus, repair of tetralogy of Fallot, and neonatal arterial switch operation to correct transposition of the great arteries. RESULTS: A significant reduction in length of hospital stay, including days in the ICU (decreased 1 to 2 days per admission), was achieved after the clinical pathway was implemented. Reductions in average duration of mechanical ventilation ranged from 28% for repair of a ventricular septal defect to 63% for repair of tetralogy of Fallot. The number of blood studies ordered decreased 20% to 30%. A significant reduction in hospital costs for each procedure, ranging from 16% to 29%, was also achieved with no adverse effects on patients' outcomes. CONCLUSIONS: Use of clinical pathways with children hospitalized for cardiac surgery can shorten length of stay in the hospital, reduce use of resources, and improve cost-effectiveness with beneficial outcomes for patients.

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