Improving treatment outcomes with a clinical pathway for hysterectomy and myomectomy.
OBJECTIVE
To determine if using a postoperative clinical pathway for women having hysterectomy or myomectomy would improve clinical care.


METHODS
Data from the literature and patient focus groups guided development of a clinical pathway. Nurses, pharmacists and physicians participated in the development process. Implementation relied on accepted quality improvement methods. We used a case-control design to compare administrative and clinical data for patients managed with (n = 28) and without (n = 28) the aid of the clinical pathway between June 1997 and January 1998.


RESULTS
Case and control groups did not differ in age, race, payer status, severity of illness or procedure type. Clinical differences between pathway and nonpathway patients included a mean six-hour-shorter period of indwelling bladder catheters (P = .019), mean 11-hour more rapid return to regular diet (P = .014) and more pain assessments among pathway patients (mean, five vs. two; P < .001). There was no significant difference in length of stay between groups. Clinicians used the pathway for approximately one year, but with personnel changes the pathway gradually fell out of use.


CONCLUSIONS
Clinical pathways can improve quality of care, even if they do not reduce length of stay. A team approach that focuses on patient concerns during pathway development may help ensure that quality improvement, rather than simply cost reduction, arises from the use of clinical pathways.
Broder
Michael S
MS
Department of Obstetrics and Gynecology, University of California, Los Angeles School of Medicine, Box 951740, Los Angeles, CA 90095-1740, USA. mbroder@ucla.edu
Bovone
Suzanne
S
D000328:Adult; D016022:Case-Control Studies; D019091:Critical Pathways; D004032:Diet; D005260:Female; D017144:Focus Groups; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain; D011182:Postoperative Care; D011787:Quality of Health Care; D016896:Treatment Outcome; D014546:Urinary Catheterization; D014594:Uterine Neoplasms / Q000601:surgery*