title: Outpatient laparoscopic cholecystectomy: patient outcomes after implementation of a clinical pathway.
abstract: OBJECTIVE
  To determine the success of a clinical pathway for outpatient laparoscopic cholecystectomy (LC) in an academic health center, and to assess the impact of pathway implementation on same-day discharge rates, safety, patient satisfaction, and resource utilization.
  
  
  BACKGROUND
  Laparoscopic cholecystectomy is reported to be safe for patients and acceptable as an outpatient procedure. Whether this experience can be translated to an academic health center or larger hospital is uncertain. Clinical pathways guide the care of specific patient populations with the goal of enhancing patient care while optimizing resource utilization. The effectiveness of these pathways in achieving their goals is not well studied.
  
  
  METHODS
  During a 12-month period beginning April 1, 1999, all patients eligible for an elective LC (n = 177) participated in a clinical pathway developed to transition LC to an outpatient procedure. These were compared with all patients undergoing elective LC (n = 208) in the 15 months immediately before pathway implementation. Successful same-day discharges, reasons for postoperative admission, readmission rates, complications, deaths, and patient satisfaction were compared. Average length of stay and total hospital costs were calculated and compared.
  
  
  RESULTS
  After pathway implementation, the proportion of same-day discharges increased significantly, from 21% to 72%. Unplanned postoperative admissions decreased as experience with the pathway increased. Patient characteristics, need for readmission, complications, and deaths were not different between the groups. Patients surveyed were highly satisfied with their care. Resource utilization declined, resulting in more available inpatient beds and substantial cost savings.
  
  
  CONCLUSIONS
  Implementation of a clinical pathway for outpatient LC was successful, safe, and satisfying for patients. Converting LC to an outpatient procedure resulted in a significant reduction in medical resource use, including a decreased length of stay and total cost of care.
authors.affiliation: Departments of Surgery and Health Evaluation Sciences, University of Virginia Health System, Charlottesville, Virginia, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Calland
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.forename: E
authors.initials: E
authors.lastname: Foley
authors.forename: V E
authors.initials: VE
authors.lastname: Bovbjerg
authors.forename: D W
authors.initials: DW
authors.lastname: Markey
authors.forename: S
authors.initials: S
authors.lastname: Blome
authors.forename: J S
authors.initials: JS
authors.lastname: Minasi
authors.forename: J B
authors.initials: JB
authors.lastname: Hanks
authors.forename: M M
authors.initials: MM
authors.lastname: Moore
authors.forename: J S
authors.initials: JS
authors.lastname: Young
authors.forename: R S
authors.initials: RS
authors.lastname: Jones
authors.forename: B D
authors.initials: BD
authors.lastname: Schirmer
authors.forename: R B
authors.initials: RB
authors.lastname: Adams
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000592:standards*; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000592:standards*; D002769:Cholelithiasis / Q000453:epidemiology / Q000601:surgery; D015897:Comorbidity; D019091:Critical Pathways; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D016896:Treatment Outcome; D014768:Virginia