Introducing a clinical pathway for acute peptic ulcer bleeding in general internal medicine wards.
OBJECTIVE
Management of acute peptic ulcer bleeding (PUB) is expensive and there is little evidence to prove the cost-effectiveness of a clinical pathway. The purpose of this study was to introduce a clinical pathway in hospitalized patients with acute PUB to evaluate its impact on costs and other outcomes.


METHODS
The clinical pathway was designed for and implemented in hospitalized patients, and a physicians reminder system that included chief residents, checklists, and case review meetings was also utilized. Use of medicine for acid suppression, length of hospital stay (LOS), and treatment costs were compared between patients before and after implementation of the clinical pathway. Outcome measures included the rate of recurrent bleeding, rate of repeat upper gastrointestinal (UGI) endoscopy, and rate of readmission within 30 days of discharge.


RESULTS
This clinical pathway significantly reduced the use of intravenous medicine for acid suppression from 88% to 34%, with mean LOS down from 6.7 to 3.6 days, mean cost of medications decreased from New Taiwan Dollars (NTD) 8768 to NTD 3940 (cost down 55.1%), mean cost of diagnostic tests lowered from NTD 12,560 to NTD 9493 (cost down 24.4%), and mean total hospital cost down from NTD 33,142 to NTD 19,519 (cost down 41.1%). Outcome measures were not significantly different.


CONCLUSIONS
Introduction of a clinical pathway is an effective method for reducing costs while maintaining quality of care in the management of PUB.
Lee
Teng-Yu
TY
Department of Internal Medicine, Division of Gastroenterology, Taichung Veterans General Hospital, Taichung, Taiwan. tylee@vghtc.gov.tw
Chan
Tam
T
Chang
Chi-Sen
CS
Lan
Joung-Liang
JL
D000208:Acute Disease; D000368:Aged; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D010438:Peptic Ulcer Hemorrhage / Q000191:economics* / Q000628:therapy; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011787:Quality of Health Care; D012008:Recurrence; D016896:Treatment Outcome
D054328:Proton Pump Inhibitors