Improvements in health care for patients undergoing thyroidectomy.
OBJECTIVE
In this study, we evaluated the effect on cost and clinical outcome of the implementation of departmental subspecialization and a clinical care pathway for patients undergoing thyroidectomy.


METHODS
Subspecialization and a clinical thyroidectomy pathway were implemented in 2001 at the Department of Surgery, National University Hospital, Singapore. A total of 150 patients (Group A) who served as controls were compared with 143 patients who were managed after implementation of subspecialization and the clinical thyroidectomy pathway (Group B). Length of stay, postoperative complications and cost per patient were compared between the two groups.


RESULTS
The mean age was 46 years and females comprised 77% of all patients. The mean length of hospital stay was shorter in Group B (1.9 days) compared with Group A (3.3 days; p < 0.001). The mean hospital charges also fell significantly after implementation, at 3,524 dollars per patient in Group B compared with 3,929 dollars in Group A (p = 0.003). There was no difference in morbidity between the two groups (2.0% and 1.4% in Groups A and B, respectively).


CONCLUSIONS
This study confirms that length of hospital stay and hospital costs are effectively reduced through the combination of subspecialization and a clinical pathway for patients undergoing thyroidectomy. Subspecialty units and pathways reduce variation in patient care. This effectively leads to better-quality outcomes, more efficient discharge planning and improved cost-effectiveness of clinical services.
Ramanujam
Lakshmi N
LN
Department of Medical Affairs, National University Hospital, Singapore.
Cheah
Wei-Keat
WK
D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D012846:Singapore; D013043:Specialties, Surgical / Q000592:standards; D013503:Surgery Department, Hospital / Q000592:standards*; D013959:Thyroid Diseases / Q000191:economics / Q000601:surgery*; D013965:Thyroidectomy / Q000191:economics / Q000592:standards*; D016896:Treatment Outcome