title: Effects of a clinical pathway for video-assisted thoracoscopic surgery (VATS) on quality and cost of care.
abstract: OBJECTIVE
  The purpose of this study was to evaluate effects of a clinical pathway (CP) for video-assisted thoracoscopic surgery (VATS) on process quality, outcome quality, and hospital costs.
  
  
  METHODS
  We implemented a CP for VATS and compared 34 patients treated with CP to 77 patients treated without CP. Indicators for process quality were duration of catheter placement, pain intensity, respiratory exercising, and mobilization. Outcome quality was measured through morbidity, mortality, reoperations, and readmissions. Cost of hospital stay was calculated using an imputed daily rate.
  
  
  RESULTS
  Foley catheters were removed significantly earlier after CP implementation. All patients on CP were mobilized and received pulmonary exercising on the operation day. Pain levels were low after CP implementation. Median hospital stay significantly reduced by 5 days. Perioperative outcome quality remained unchanged. Costs significantly diminished by 1,510 Euro per stay.
  
  
  CONCLUSIONS
  CP implementation had positive effects on process quality. Specifically, catheter management was improved and a good pain control achieved. Patients benefited from shortened stay and were treated at lower cost. A clear effect on outcome quality was not found. CPs are a promising tool for quality improvement and cost containment in thoracic surgery.
authors.affiliation: Department of Surgery, Division of Surgical Oncology and Thoracic Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68135, Mannheim, Germany. matthias.schwarzbach@umm.de
authors.forename: Matthias H M
authors.initials: MH
authors.lastname: Schwarzbach
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ronellenfitsch
authors.forename: Qian
authors.initials: Q
authors.lastname: Wang
authors.forename: Eric D
authors.initials: ED
authors.lastname: Rössner
authors.forename: Christof
authors.initials: C
authors.lastname: Denz
authors.forename: Stefan
authors.initials: S
authors.lastname: Post
authors.forename: Peter
authors.initials: P
authors.lastname: Hohenberger
mesh_terms: D000368:Aged; D019091:Critical Pathways; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012140:Respiratory Tract Diseases / Q000191:economics / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics; D016896:Treatment Outcome