Designing a carotid endarterectomy critical pathway for your organization.
BACKGROUND
Carotid endarterectomy (CEA) is one of the top-five surgical diagnosis-related groups at Keesler Medical Center. The geometric mean length of stay for CEA during fiscal year (FY) 1996 was 5.84 days (N = 41), compared with 1.79 for a benchmark facility.


OBJECTIVE
Create a critical pathway to standardize care, maintain/improve patient outcomes, reduce lengths of stay, and decrease costs.


METHODS
A multidisciplinary team was formed to evaluate four patient-flow options. The team decided to discharge patients directly from the intensive care unit to meet both patient and staff needs.


RESULTS
The geometric mean length of stay decreased to 1.70 days (N = 54) in FY 1998, compared with 2.42 days (N = 40) in FY 1997. The cost savings ws $5,841 per case, compared with $1,684 before creation of the pathway. This represents an annual savings of more than $224,000 and a 30% reduction in length of stay.


CONCLUSIONS
The CEA pathway has standardized the care received by this group of patients. By decreasing variation, processes have become routine and more efficient.
Jano
S
S
Department of Surgery, Keesler Medical Center, Keesler Air Force Base, MS 39534, USA.
Harlin
S A
SA
D000368:Aged; D019985:Benchmarking / Q000458:organization & administration; D003363:Cost Control; D017046:Cost Savings; D019091:Critical Pathways / Q000458:organization & administration*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008922:Mississippi; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration; D016730:Program Development / Q000379:methods; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D017749:Total Quality Management / Q000458:organization & administration