title: Pulmonary lobectomy patient care pathway: a model to control cost and maintain quality.
abstract: BACKGROUND
  Cost containment is a reality in thoracic surgery. Patient care pathways have proved effective in cardiac surgery to reduce length of stay and control costs.
  
  
  METHODS
  A multidisciplinary team formulated a pulmonary lobectomy patient care pathway to standardize care, reduce length of stay and costs, and maintain quality. Variance codes were developed to collect data prospectively on reasons for prolonged stay. A patient satisfaction survey was instituted to learn patients' responses to their hospitalization.
  
  
  RESULTS
  One hundred forty-seven patients underwent lobectomy in 1995 before institution of the pathway with a mean length of stay of 10.6 days and a mean cost of $16,063. The lobectomy pathway was instituted at the beginning of 1996. One hundred thirty patients underwent lobectomy in 1996 with a mean length of stay of 7.5 days (p = 0.03) and a mean cost of $14,792 (p = 0.47). Readmission and mortality rates were unchanged. Eighty-eight of 130 patients (68%) were able to be discharged by the target length of stay of 7 days in 1996 as opposed to 76 of 147 patients (52%) in 1995. The most common reason for delayed discharge was inadequate pain control. The majority of patients felt prepared for discharge by the seventh postoperative day (70 of 96 patients, 73%).
  
  
  CONCLUSIONS
  The institution of a lobectomy patient care pathway appeared to reduce length of stay and costs. The pathway provided a framework to begin systematic quality control measures to enhance patient care.
authors.affiliation: General Thoracic Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Wright
authors.forename: J C
authors.initials: JC
authors.lastname: Wain
authors.forename: H C
authors.initials: HC
authors.lastname: Grillo
authors.forename: A C
authors.initials: AC
authors.lastname: Moncure
authors.forename: S M
authors.initials: SM
authors.lastname: Macaluso
authors.forename: D J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D003363:Cost Control; D019091:Critical Pathways / Q000191:economics*; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D010359:Patient Readmission; D017060:Patient Satisfaction; D011013:Pneumonectomy / Q000191:economics* / Q000401:mortality; D011183:Postoperative Complications; D011785:Quality Assurance, Health Care