title: Effects of a clinical pathway 3 years after implementation in breast surgery.
abstract: OBJECTIVE
  The aim of the present study is to evaluate the effects of the implementation of clinical pathways into routine practice of breast surgery.
  
  
  METHODS
  We implemented a clinical pathway for breast surgery in 2006 and analysed for the following 3 years its path in respect to hospital stay, total costs per case, readmission rate, and patients' satisfaction.
  
  
  RESULTS
  The mean hospital stay decreased significantly from 4.5 days in 2006 to 3.7 days in 2007 and revealed 3.4 days in 2008. This is a decrease by 24.4% for the duration of hospital stay. The total cost per case between 2006 and 2007 showed a significant decrease of 23.4%. The total costs increased by 13.4% in 2008. Readmission rate was under 5% and remained constant. Patients' satisfaction remained constant, whereby more than 90% of the expected good results were attained.
  
  
  CONCLUSIONS
  There is substantial evidence that clinical pathways lead to various improvements in clinical care in surgery. We show a constantly significant effect on duration of hospital stay without any increase in the number of readmissions. In our view, it is not only an economic benefit which prevails here, but also especially a transparency of treatment which leads to higher compliance, better outcome and a shorter length of stay.
authors.affiliation: Department of Gynecology, Interdisciplinary Breast Center, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany. christiane.richter-ehrenstein@charite.de
authors.forename: C
authors.initials: C
authors.lastname: Richter-Ehrenstein
authors.forename: S
authors.initials: S
authors.lastname: Heymann
authors.forename: A
authors.initials: A
authors.lastname: Schneider
authors.forename: O
authors.initials: O
authors.lastname: Vargas Hein
mesh_terms: D001943:Breast Neoplasms / Q000191:economics* / Q000601:surgery*; D016009:Chi-Square Distribution; D019091:Critical Pathways / Q000191:economics; D005260:Female; D005858:Germany; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016462:Mammaplasty / Q000191:economics; D008408:Mastectomy / Q000191:economics; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data