title: [Evaluation of a clinical pathway for laparoscopic cholecystectomy].
abstract: BACKGROUND
  Clinical pathways are standardized plans for the integral care of specific processes. In March 2002, a clinical pathway for laparoscopic cholecystectomy was introduced in our service. The aim of the present study was to evaluate this pathway 1 year after its implementation.
  
  
  METHODS
  All patients included in the clinical pathway since its introduction were studied. Evaluation criteria included compliance, indicators of the effectiveness of clinical care, economic impact and indicators of satisfaction based on a survey. The results were compared with those in a series of patients who underwent surgery in the year before the introduction of the clinical pathway. Our hospital uses analytical accounting and the mean cost per process before and after the introduction of the clinical pathway was analyzed.
  
  
  RESULTS
  A series of 160 consecutive patients who underwent surgery during the year prior to the creation of the clinical pathway and who fulfilled the accepted inclusion criteria was evaluated. The mean length of hospital stay was 3.27 days. The mean cost per process before the introduction of the pathway was 2149 (+/- 768) euros. During the first year after the introduction of the pathway, 140 patients were included with an inclusion rate of 100%. The mean length of hospital stay in patients included in the clinical pathway was 2.2 days. The degree of compliance with length of hospital stay was 66.7%. The most frequent causes of breach were staff-related, followed by patient-related (oral intolerance, pain, etc.). The mean cost in patients included in the clinical pathway was 1845 (+/- 618) euros.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy is a suitable process with which to initiate systematization of clinical pathways. The results show that length of hospital stay has been significantly reduced without increasing morbidity. Patient satisfaction has been high.
authors.affiliation: Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario J.M. Morales Meseguer, Murcia, España. vsaledo@yahoo.es
authors.forename: Víctor
authors.initials: V
authors.lastname: Soria-Aledo
authors.forename: Enrique
authors.initials: E
authors.lastname: Pellicer
authors.forename: María Fe
authors.initials: MF
authors.lastname: Candel-Arenas
authors.forename: Benito
authors.initials: B
authors.lastname: Flores-Pastor
authors.forename: Milagros
authors.initials: M
authors.lastname: Carrasco-Prats
authors.forename: Joana
authors.initials: J
authors.lastname: Miguel-Perelló
authors.forename: Alvaro
authors.initials: A
authors.lastname: Campillo
authors.forename: José Luis
authors.initials: JL
authors.lastname: Aguayo-Albasini
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000592:standards*; D019091:Critical Pathways; D017721:Hospital Costs / Q000706:statistics & numerical data / Q000639:trends; D006785:Hospitals, University / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends; D013030:Spain