title: A clinical pathway for laparoscopic pyeloplasty decreases length of stay.
abstract: OBJECTIVE
  Benefits of minimally invasive procedures include decreased hospitalization and recovery times. Decreased length of stay (LOS) improves hospital efficiency and decreases costs. However, decreasing the LOS at the expense of patient care and satisfaction is not acceptable. A clinical pathway (CP) with structured order sets and imaging was developed for patients undergoing laparoscopic pyeloplasty. This pathway includes a cascade of activities managed closely by the health care team. This study assesses the safety and patient satisfaction with this clinical pathway.
  
  
  METHODS
  We reviewed all adult pyeloplasties (39) completed laparoscopically since November 2001. All patients were managed according to the CP developed for the laparoscopic pyeloplasty procedure. The length of stay was measured in days. Patient satisfaction was assessed with a standardized questionnaire. Any readmissions or emergency room visits were documented.
  
  
  RESULTS
  The mean length of stay was 1.10 days. Of 39 patients 37 (94%) were discharged home on postoperative day 1. One patient with severe postoperative pain required intravenous analgesia. She had undergone complex upper tract reconstruction and stayed a total of 4 days. One patient, who had a previous failed endopyelotomy, remained 2 days for persistent nausea. No patients sought emergency room consultation and there were no readmissions. Of 39 patients 34 (87%) completed the questionnaire and satisfaction was high.
  
  
  CONCLUSIONS
  The implementation of a CP at our institution has standardized patient care in this population and decreased LOS in comparison to the literature. This improves bed use and hospital efficiency while maintaining a high degree of patient satisfaction. We conclude that with intensive patient care and education most patients undergoing laparoscopic pyeloplasty may be discharged home safely on postoperative day 1.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Webster
authors.forename: Roxelyn
authors.initials: R
authors.lastname: Baumgartner
authors.forename: Jason K
authors.initials: JK
authors.lastname: Sprunger
authors.forename: D Duane
authors.initials: DD
authors.lastname: Baldwin
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: S Duke
authors.initials: SD
authors.lastname: Herrell
mesh_terms: D000046:Academic Medical Centers; D019091:Critical Pathways; D017598:Efficiency, Organizational; D006801:Humans; D007677:Kidney Function Tests; D007682:Kidney Pelvis / Q000601:surgery*; D010535:Laparoscopy / Q000523:psychology / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data*; D010147:Pain Measurement; D010348:Patient Care Team; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D013714:Tennessee