Effects of a clinical pathway on quality of care in kidney transplantation: a non-randomized clinical trial.
OBJECTIVE
Standardization of care is essential for improving outcome of kidney transplantation (KT). Clinical pathways (CPs) are known to standardize and improve perioperative care for a number of interventions. In transplantation medicine, however, pertinent evidence is very limited. This study evaluates effects of a CP on quality of care in KT.


METHODS
Consecutive patients (n=32) undergoing KT between July 2006 and August 2007 who were treated with a CP were compared to patients (n=44) treated without CP between January 2005 and June 2006. Several quality indicators regarding process and outcome were compared between groups.


RESULTS
Quality of care was significantly higher in the CP group for the following indicators: timely removal of central venous catheters, wound drains, and Foley catheters and control of cyclosporine levels, respiratory exercising, and pain control. Median stay decreased non-significantly from 21.4 to 18.3 days. There was significantly less delayed graft function in the CP group. All other outcome indicators showed no significant differences.


CONCLUSIONS
Implementation of a CP for KT improves the quality of perioperative treatment by standardizing care. Regarding effects on outcome, no clear conclusion can be drawn. We recommend that large randomized studies are conducted to evaluate the latter issue.
Schwarzbach
Matthias
M
Department of Surgery, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, 68135 Mannheim, Germany. matthias.schwarzbach@umm.de
Bönninghoff
Roderich
R
Harrer
Katrin
K
Weiss
Johannes
J
Denz
Christof
C
Schnülle
Peter
P
Birck
Rainer
R
Post
Stefan
S
Ronellenfitsch
Ulrich
U
D000328:Adult; D000368:Aged; D002102:Cadaver; D019091:Critical Pathways / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011336:Probability; D015397:Program Evaluation; D011446:Prospective Studies; D011787:Quality of Health Care; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome