[Design and use of patient pathways in general surgery].
BACKGROUND
Clinical pathways are a new initiative intended to reduce costs while maintaining or even improving the quality of care. Based on treatment guidelines, patient pathways display an optimal sequence of staff actions in the preoperative, operative, and postoperative in- and outpatient treatment.


METHODS
In this study, patient pathways were developed for selected elective general surgical disease entities following a new modular approach. All elements of care and their direct costs to the hospital were identified. Multidisciplinary teams of physicians, nurses, and administrative staff constructed and implemented the patient pathways.


RESULTS
In the 1-year pilot phase, we developed and implemented 7 pathways with 16 subpathways: open herniorrhaphy, laparoscopic cholecystectomy and fundoplication, thyroidectomy, surgical treatment of diverticulitis and colon carcinoma and kidney transplantation.


CONCLUSIONS
Patient pathways combine the management of care, hospital processes, and costs in a new integrated concept. Patient pathways streamline and standardize care, facilitate communication, and contribute to cost control efforts.
Wicke
C
C
Klinik für Allgemeine Chirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. corinna.wicke@med.uni-tuebingen.de
Teichmann
R
R
Holler
T
T
Rehder
F
F
Becker
H D
HD
D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000592:standards; D003110:Colonic Neoplasms / Q000601:surgery; D003363:Cost Control; D019091:Critical Pathways; D004238:Diverticulitis / Q000601:surgery; D018662:Fundoplication / Q000191:economics / Q000592:standards; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics / Q000592:standards; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D013514:Surgical Procedures, Operative / Q000191:economics / Q000592:standards*; D013965:Thyroidectomy / Q000191:economics / Q000592:standards