[Effects of implementing clinical pathways for the care of patients undergoing ophthalmic surgery for cataract, glaucoma, and vitreoretinal disorder].
OBJECTIVE
To evaluate the actual use of clinical pathways and variances, and compare the length of hospital stay for surgery of cataract, glaucoma, and vitreoretinal disorder.


METHODS
We designed eight types of clinical pathways for the treatment of cataract, glaucoma, and retinal-vitreous disease. We performed 102 phacoemulsifications and intraocular lens (IOL) implantations, 19 glaucoma or combined trabeculotomy and phacoemulsification/IOL, and 69 retinal-vitreous surgeries during a 1-year period from February 2002. We compared the length of the hospital stay before and after clinical pathway implementation.


RESULTS
We applied the clinical pathways to 102 eyes (100%) of 67 patients undergoing phacoemulsification/IOL, to 17 eyes (89.5%) of those undergoing glaucoma surgery, and to 69 eyes (100%) of those undergoing retinal-vitreous surgery. The vaiances occurred in 20 eyes (29.9%) of 67 phacoemulsification/IOLs, 6 eyes (31.6%) of glaucoma, and 24 eyes (34.2%) of retinal-vitreous surgery. The length of hospital stay was shortened in phacomulsification/IOL after clinical pathway implemenation: 7.8 +/- 3.3 to 6.7 +/- 2.5 (mean +/- standard deviation) days. Glaucoma patients had a significantly shorter stay, from 16.4 +/- 5.0 to 12.6 +/- 3.3 days Mann-Whitney U test ; p = 0.032), and the hospital tay for retinal-vitreous surgery was shortened rom 22.8 +/- 11.1 to 17.9 +/- 6.2 days (p = 0.001).


CONCLUSIONS
The application of clinical pathways resulted in substantially reduced hospital stay.
Department of Ophthalmology, University of Occupational and Environmental Health, Kitakyushu, Japan.
Toshiaki
T
Kubota
Akihiko
A
Nakamura
Junko
J
Wakiya-Matsuo
Yasutaka
Y
Mochizuki
Naoko
N
Onizuka
Yayoi
Y
Suyama
Miho
M
Miyazaki
Akihiko
A
Tawara
D002387:Cataract Extraction; D019091:Critical Pathways; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D019654:Lens Implantation, Intraocular; D018918:Phacoemulsification; D012164:Retinal Diseases / Q000601:surgery*; D014130:Trabeculectomy; D014822:Vitreous Body / Q000601:surgery*