[Process optimization in ENT: clinical pathways and central induction area].
BACKGROUND
Owing to the rising costs in the health care system, it is now important to optimize processes through standardization and process consolidation. A lack of process consolidation in this area of operation or overly long durations of stay of patients in the hospital can lead to increased costs for the ENT department. The aim of this study was to examine whether process optimization could be achieved through close interdisciplinary networking with clinical pathways and central induction (CI).


METHODS
In the 1-year periods before and after the implementation of CI, turnover times in the ENT department were retrospectively examined and 2,433 patients from the entire operative ENT spectrum were included. The average durations of stay before and after the implementation of the "septoplasty" pathway were additionally evaluated.


RESULTS
ENT turnover times were significantly reduced after the introduction of CI. In comparison to the conventional anaesthesia process, the turnover times using CI were on average 10 min shorter. Furthermore, since the introduction of pathways, the duration of stay for ENT patients could be significantly reduced while simultaneously maintaining the quality of care. This process was statistically evaluated using septoplasty in nasal surgery as a typical example and the duration of stay was reduced from 5.85 days to 4.32 (a reduction of 26%) or 3.55 days (a reduction of 34%).


CONCLUSIONS
The combination of CI and pathways is a suitable means to increase the clinical and economic effectiveness even when the new case-based flat-rate system is taken into consideration.
Göktas
O
O
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland. oender.goektas@charite.de
Fleiner
F
F
Spies
C
C
Krieg
H
H
Bauer
K
K
Sedlmaier
B
B
D000293:Adolescent; D000758:Anesthesia / Q000592:standards*; D000762:Anesthesia Recovery Period; D003299:Cooperative Behavior; D019091:Critical Pathways / Q000592:standards*; D003953:Diagnosis-Related Groups / Q000592:standards; D004282:Documentation / Q000592:standards; D005858:Germany; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data; D016347:Medical Records Systems, Computerized / Q000592:standards; D009300:Nasal Septum / Q000601:surgery; D009313:National Health Programs; D010036:Otolaryngology / Q000592:standards*; D012189:Retrospective Studies; D012225:Rhinoplasty / Q000592:standards; D012984:Software