Effects of Implementation of a National Fast Track Clinical Pathway for Hepatocellular Carcinoma in Western Denmark

Background & Aims: In 2009, the Danish Government instituted “Fast Track Clinical Pathways” (FTCP) to accelerate diagnosis and treatment of cancers including hepatocellular carcinoma (HCC). We examined how the implementation of FTCP affected the time from referral to diagnosis and treatment as well as the patient survival.Methods: 309 consecutive patients with suspected HCC were included, 79 referred during the period 2007- 2008 (before FTCP) and 230 during 2009-2011. Of those, 271 (88%) were diagnosed with HCC and 161 (60%) had cirrhosis, in most cases caused by alcohol.Results: The time from referral to the first visit was reduced from a mean 16.4 (11.5) to 5.4 (6) days (p<0.001) and the time from the first visit to the Multidisciplinary Tumour Conference (MDT) treatment decision from 34.9 (27.9) to 16.1 (14.4) days (p<0.001). The total time from referral to treatment was reduced from 53.2 (37.9) to 35.9 (23.1) days (p<0.001). There was a weak trend of improved survival after FTCP: 231 (147-368)vs. 293 (227-396) days (p=0.11).Conclusions: The implementation of FTCP reduced the total time from referral to treatment by three weeks; however, without significant effects on overall mortality. While shortened waiting time is a comfort for the patient, it remains to be elucidated whether it will change the prognosis.

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Implementation and evaluation of the clinical pathway for the diagnosis and treatment of acute coronary syndrome

Journal of Chitwan Medical College ◽

10.3126/jcmc.v8i1.23718 ◽

2018 ◽

Vol 8 (1) ◽

pp. 46-53

Author(s):

Bishnu Mani Dhital ◽

Ou Yang Mao ◽

Shyam Raj Regmi ◽

Sudhir Regmi

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Pathway ◽

Clinical Pathways ◽

Final Diagnosis ◽

Developed Countries ◽

Diagnosis And Treatment ◽

Coronary Syndrome ◽

Significant Difference ◽

Tertiary Hospitals ◽

Timi Risk Score

Background: The clinical pathways have been developed to guide and standardize diagnosis, treatment of certain diseases, optimize smooth patient care, and its application has been proven to regulate the medical practice and to improve the quality of medical care in developed countries. Objective: To analyze and evaluate the diagnosis and treatment of acute coronary syndrome (ACS) after the implementation of clinical pathways and to identify the areas need to be improved in clinical practice in Xiangya Third Hospital of Central South University. Methods: 250 ACS patients, divided into five groups 50 in each, were collected from December 2009 to December 2011, the first group was considered as baseline and compared with other four group. All these data were compared and analyzed with other tertiary hospitals of china. Results: STEMI patients arriving within 12 hours of onset of symptoms was increased (P<0.05), and final diagnosis consistent with cardiac markers was also increased (P<0.05).Use of aspirin, clopidogrel, β-Blocker, ACEI /ARB, and statin was higher (P>0.05), but the use of clopidogrel and statin was significantly higher (P<0.05) than other hospitals; no significant difference (P>0.05) in Door-to-needle time or Door-to-balloon time, though longer than standard guidelines, but the door-to-needle time was shorter when compared with other hospitals. TIMI risk score of UA/NSTEMI patients and invasive therapy (PCI) was negatively correlated (r = -0.312, P<0.05), and results were similar when compared with other hospitals; high-risk patients increased, but no significant difference in mortality (P>0.05). Conclusion: Implementation of Clinical pathway may help to improve patient outcome with early invasive and medical therapy.

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